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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[PennDippody]

Has to be A then. An ESR of 100 is extremely unlikely to be a false negative, so I don't think repeating it would be beneficial. You probably would order CRP, CBC, and biopsy, and treat if you see elevated CRP, normocytic normochromic anemia and thrombocytosis, while waiting for biopsy results.

As I mentioned before, I think they are going more for the stats in this question than expecting us to know specific MDM required for TA, especially without giving us H&P. So from a stats perspective, with 50% pretest probability and only 60% specificity, I think they would expect more tests for confirmation.

It is a stats question . She screened positive with a highly sensitive test. Due to the tests weak specificity and stated treatment risk, a confirmatory test (with high specificity) is warranted. The disease specifics are unimportant in this question's case.

 

[pd1112]

It is a stats question . She screened positive with a highly sensitive test. Due to the tests weak specificity and stated treatment risk, a confirmatory test (with high specificity) is warranted. The disease specifics are unimportant in this question's case.

Yeah, essentially exactly what I said

 

[Hakeem-Almedico]

An 80-year-old woman comes to the emergency department because of a 2-day history of "feeling funny." She says, "I have lost my pep." She has never been admitted to the hospital, but she has a history of poorly controlled hypertension. She just started a medication 2 weeks ago but does not recall the name. Her blood pressure is 130/85 mm Hg. Physical examination shows no abnormalities. Her serum potassium concentration is 3 mEq/L. Which of the following drugs is the most likely cause of this patient's condition?
A
) Clonidine
B
) Hydrochlorothiazide
C
) Lisinopril
D
) Metoprolol
E
) Triamterene

 

[Hakeem-Almedico]

 

[ewax]

View attachment 193540

B. HCTZ is the only one of these drugs that causes hypokalemia.

 

[study for usmle nbme]

I think the most right answer is A, going for biopsy +/- CRP. It's extremely unlikely that ESR would be falsely elevated as high as 100, and it commonly reaches levels that high in TA. So a repeat ESR would be useless acutely, IMO. I think they are trying to get at something with the stats here, as the post-test probability is ~71%, but I don't know what that means as far as next best step. The best answer would be B if not for the 99% certainty part, because you would want to treat empirically while waiting on biopsy results to reduce risk of permanent vision loss. I don't see repeating an ESR as beneficial as you would still have the same rate of false positives if you thought 100 could possibly be a false positive.

yes i agree its A as best answer coz option B adds certainity of 99% which is not true coz question says its sensitive in 99% and as we know sensitivity rules out of not having the disease it doesnt mean the disease is diagnosed had it been 99%specific thn defintely the answer would be B however the specifity is only 60% so with 99% sensitivity your next best move is to confirm the disease and then treatment should me iniated .

 

[pd1112]

yes i agree its A as best answer coz option B adds certainity of 99% which is not true coz question says its sensitive in 99% and as we know sensitivity rules out of not having the disease it doesnt mean the disease is diagnosed had it been 99%specific thn defintely the answer would be B however the specifity is only 60% so with 99% sensitivity your next best move is to confirm the disease and then treatment should me iniated .

Yeah essentially exactly what I said.

 

[study for usmle nbme]

I don't remember the choices, but I think it was 9 months. I put the answer choice right under 1 year but not as low as 6 months(which I think was another choice)

The milestones are literally the only section in FA I refuse to learn and memorize haha but got lucky with this question. Im going off walking and babinski if it comes up on the real deal

3 months can't stand up
12 months should be able to stand freely, so 9 months you can hold the table and stand
6 months sweeping w/ arms and 9 months some better fine motor skills (pincer grasp)

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.

the chronological progression in girls is :thelarche ->adrenarche/pubarche ->peak height velocity(PHV)->menarche
and in boys it is :testicular growth more than 2.5cm and volume more than 4cc->adrenarche//pubarche ->penile growth->PHV

 

[jaydee101]

25-year-old woman comes to physician because of a 3-year history of irregular menses. Puberty began at age 12 and progressed normally. Her blood pressure is 116/62 mm Hg. Physical ecam shows increased hair growth on face and chest. Pelvic examination showed clitoromegaly and normal-appearing uterus. Serum studies show increased concentration of 17-Hydroxyprogesterone and androstenedione. The pt most likely has a deficiency of which of the following enzymes?

A 11B-hydroxylase
B 17a-Hydroxylase
C 21-Hydroxylase
D 3B-Hydroxysteroid Dehydrogenase
E 5a-Reductase

I went with 11a-hydroxylase because it seems she has normal blood pressure. People posted earlier saying she has low blood pressure and so it should be 21a. I thought hypotension/low blood pressure is anything below 90/60. I considered 21 but I ended up going with 17 because there were no other signs of aldosterone problems besides slightly lower BP. Can somebody explain this please?

Thanks

[Edited]

 

[seminoma]

25-year-old woman comes to physician because of a 3-year history of irregular menses. Puberty began at age 12 and progressed normally. Her blood pressure is 116/62 mm Hg. Physical ecam shows increased hair growth on face and chest. Pelvic examination showed clitoromegaly and normal-appearing uterus. Serum studies show increased concentration of 17-Hydroxyprogesterone and androstenedione. The pt most likely has a deficiency of which of the following enzymes?

A 11B-hydroxylase
B 17a-Hydroxylase
C 21-Hydroxylase
D 3B-Hydroxysteroid Dehydrogenase
E 5a-Reductase

I went with 17a-hydroxylase because it seems she has normal blood pressure. People posted earlier saying she has low blood pressure and so it should be 21a. I thought hypotension/low blood pressure is anything below 90/60. I considered 21 but I ended up going with 17 because there were no other signs of aldosterone problems besides slightly lower BP. Can somebody explain this please?

Thanks

There's no way this is 17a because she has increased concentration of 17-oh-progesterone, which requires 17-a-ohase and 3-b-hsd to be formed.

However you are correct that this patient is not hypotensive. Imo the real question here is between 21 and 11. The answer is 21 because she is normotensive vs hypertensive (as in 11).

 

[jaydee101]

There's no way this is 17a because she has increased concentration of 17-oh-progesterone, which requires 17-a-ohase and 3-b-hsd to be formed.

However you are correct that this patient is not hypotensive. Imo the real question here is between 21 and 11. The answer is 21 because she is normotensive vs hypertensive (as in 11).

Sorry I meant to put down 11B. Should have proof read my response. I could not tell which one they wanted. Her blood pressure seemed normal and I figured if she had a 21 def, she would show signs of it very early as a child because of the lack of aldosterone. I went with 11b because I thought that deficiency would be much milder in presentation. This is one of those questions that was a complete head scratcher.

Based on what your saying, if they are hypertensive then it is 11B and if they are normotensive then it is 21? For some reason that isn't making much sense. I figure the lack of aldosterone would mean low BP means 21 def and normal BP or close to normal BP would be 11b.

 

[dfib slim]

if they are hypertensive then it is 11B and if they are normotensive or hypotensive then it is 21?

There are classic and non classic types of 21a def. She looks like she has the non salt wasting type leaving her normotensive. Also the elevation of 17-Hydroxyprogesterone and androstenedione is a dead giveaway.

 

[seminoma]

Sorry I meant to put down 11B. Should have proof read my response. I could not tell which one they wanted. Her blood pressure seemed normal and I figured if she had a 21 def, she would show signs of it very early as a child because of the lack of aldosterone. I went with 11b because I thought that deficiency would be much milder in presentation. This is one of those questions that was a complete head scratcher.

Based on what your saying, if they are hypertensive then it is 11B and if they are normotensive then it is 21? For some reason that isn't making much sense. I figure the lack of aldosterone would mean low BP means 21 def and normal BP or close to normal BP would be 11b.

As mentioned above there are various forms of 21 deficiency. I personally don't remember them all, but from a physio point of view an 11 deficiency is always going to result in hypertension because of 11doc.

So basically if they are normotensive at baseline then it's highly unlikely to be 11 deficiency

 

[jaydee101]

As mentioned above there are various forms of 21 deficiency. I personally don't remember them all, but from a physio point of view an 11 deficiency is always going to result in hypertension because of 11doc.

So basically if they are normotensive at baseline then it's highly unlikely to be 11 deficiency

Ok that makes sense. Thanks for the clarification

 

[shiralad]

Thanks, but I'm confused because FA says TNF-alpha is a mediator of septic shock, causes leukocyte recruitment and vascular leak? that seems applicable here?

you are all right in your assumption ...TNF alpha and il 1 are mediators for shock which is this pte condition

 

[shiralad]

Can someone talk me through the sickle cell kid with osteomyelitis in his foot?

I struggled to choose between osteomyelitis and avascular necrosis for several reasons.

Things supporting osteomyelitis.
Location (strange for AVN to be in the toes/feet in this pt)

Things supporting AVN
Kid is only 3 years old so he's not asplenic yet, right?

I ended up choosing osteomyelitis because I was thinking fever+pain+white count was more suggestive of osteomyelitis, but I'm not completely sure that AVN doesn't present with fever+pain+white count too..

i put osteomyelitis due to salmonella infection in sickle cell disease

 

[shiralad]

the Answer is B.
ok so TPMT breaks down 6-MP. So if there is a homozygous for low activity of TPMP... he wouldn't break down as much 6-MP as a normal person would. Hence the level of 6-MP would increase.
So for treatment of ALL.. we would give decreased amount of 6-MP as it won't be broken down by one of the pathways.

 

[shiralad]

Hey. A friend of mine scored 5 points higher than NBME 17.
He got 232 in NBME and scored 237.
I am waiting for my result. Will update you next week

 

[shiralad]

the Answer is B.
ok so TPMT breaks down 6-MP. So if there is a homozygous for low activity of TPMP... he wouldn't break down as much 6-MP as a normal person would. Hence the level of 6-MP would increase.
So for treatment of ALL.. we would give decreased amount of 6-MP as it won't be broken down by one of the pathways.

Hi , there i would like to help you but u most tell me how can i get into the attachment because every time i click them an error message shows up

 

[torreceptor]

40 yof 6 month hx of episodic sinusitis now comes with 2wk hx of intermittent headaches fatigue gen. pain worsening cough now productive blood tinged sputum rx with antibiotics decongestans nasal corticosteroids didnt improve her sinus related prbs
p/e shows nasal mucosa erythema with small ulcerations auscultation lungs show scat. crackles x ray reveals pathchy opacities B/L labs
Hb 13
ESR 70
WBC 10500
serum ANCA increased
dx?
a ) allergic bronchopulmonary aspergilosis
b) Churg-strauss syndrome
c) Sarcoidosis
d) Tuberculosis
e ) Wegener granulomatosis

i think its E)

 

[dfib slim]

40 yof 6 month hx of episodic sinusitis now comes with 2wk hx of intermittent headaches fatigue gen. pain worsening cough now productive blood tinged sputum rx with antibiotics decongestans nasal corticosteroids didnt improve her sinus related prbs
p/e shows nasal mucosa erythema with small ulcerations auscultation lungs show scat. crackles x ray reveals pathchy opacities B/L labs
Hb 13
ESR 70
WBC 10500
serum ANCA increased
dx?
a ) allergic bronchopulmonary aspergilosis
b) Churg-strauss syndrome
c) Sarcoidosis
d) Tuberculosis
e ) Wegener granulomatosis

i think its E)

Yes, classic Wegners

 

[Mr.wonderful]

Hi guys
I ve got the following wrong .. need some help



there was a Q with a brain stem section and labeled structures .. i got it wrong i thought the answer is right MLF damage .. this is the Qstem

A 28-year-old woman is brought to the physician because of a 3-week history of double vision. One year ago, she had an episode of blurry vision in her left eye that gradually improved during the next 2 months without treatment. Neurologic examination shows that the right eye does not adduct past the midline on horizontal gaze when looking to the left. When convergence is tested, the right eye is able to adduct past the midline. Rightward horizontal gaze is normal. This patient most likely has a lesion involving which of the following labeled structures in the photograph of the brain stem shown?

i picked F , was wrong


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10. A 50-year-old man who has smoked 2 packs of cigarettes a day for 34 years has experienced gradually increasing shortness of breath on exertion, chronic cough productive of thick sputum, and frequent episodes of wheezing. The anteroposterior diameter of his chest is increased. Diminished breath sounds and scattered rhonchi are audible throughout the lung fields. Which of the following laboratory abnormalities is expected?
A
) Decreased blood Pco2
B
) Increased blood HCO3−
C
) Increased blood pH
D
) Increased urinary excretion of HCO3−
E
) Increased urinary pH (picked this , was wrong)

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A 24-year-old man with a history of intravenous drug use is brought to the emergency department by his roommate 30 minutes after he could not be aroused. The friend reports that the patient injected himself with a drug approximately 6 hours ago. Laboratory studies show a serum drug concentration of 0.30 mg/L. Assuming the drug exhibits first-order one-compartment kinetics, has a half-life of2 hours, and a volume of distribution of 200 L in this patient, which of the following is the most likely approximate quantity of the drug (in mg) injected?
A
) 300
B
) 480
C
) 600
D
) 1000
E
) 1250

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44. A 58-year-old man with supraventricular tachyarrhythmia refractory to pharmacotherapy undergoes ablation of an accessory excitatory pathway in the atrial endocardium. Which of the following areas should be avoided to leave the sinoatrial (pacemaker) node intact in this patient?
A
) Inferior to the opening of the coronary sinus
B
) The joining of the pulmonary vein and the left atrium
C
) The junction of the superior vena cava and the right atrium
D
) The opening of the inferior vena cava as it enters the right atrium
E
) Within the fossa ovalis

------------




thanks in advance

 

[sabrefresco]

Hi guys
I ve got the following wrong .. need some help



there was a Q with a brain stem section and labeled structures .. i got it wrong i thought the answer is right MLF damage .. this is the Qstem

A 28-year-old woman is brought to the physician because of a 3-week history of double vision. One year ago, she had an episode of blurry vision in her left eye that gradually improved during the next 2 months without treatment. Neurologic examination shows that the right eye does not adduct past the midline on horizontal gaze when looking to the left. When convergence is tested, the right eye is able to adduct past the midline. Rightward horizontal gaze is normal. This patient most likely has a lesion involving which of the following labeled structures in the photograph of the brain stem shown?

i picked F , was wrong

It was C or D. Right-sided MLF. (Internuclear Ophthalmoplegia). EDIT: It was C. INO affects ipsilateral side.


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10. A 50-year-old man who has smoked 2 packs of cigarettes a day for 34 years has experienced gradually increasing shortness of breath on exertion, chronic cough productive of thick sputum, and frequent episodes of wheezing. The anteroposterior diameter of his chest is increased. Diminished breath sounds and scattered rhonchi are audible throughout the lung fields. Which of the following laboratory abnormalities is expected?
A
) Decreased blood Pco2
B
) Increased blood HCO3− (Classic COPD->Increased PCO2->Decreased pH->Increased HCO3- as compensation)
C
) Increased blood pH
D
) Increased urinary excretion of HCO3−
E
) Increased urinary pH (picked this , was wrong)

----
A 24-year-old man with a history of intravenous drug use is brought to the emergency department by his roommate 30 minutes after he could not be aroused. The friend reports that the patient injected himself with a drug approximately 6 hours ago. Laboratory studies show a serum drug concentration of 0.30 mg/L. Assuming the drug exhibits first-order one-compartment kinetics, has a half-life of2 hours, and a volume of distribution of 200 L in this patient, which of the following is the most likely approximate quantity of the drug (in mg) injected?
A
) 300
B
) 480 (6hrs post injection. So 3 half lives by now. Which means initial concentration of drug in the plasma was (0.3*2*2*2). Multiply that with 200 (Volume of distribution to get amount of drug that was in the body in mg)
C
) 600
D
) 1000
E
) 1250

-----

44. A 58-year-old man with supraventricular tachyarrhythmia refractory to pharmacotherapy undergoes ablation of an accessory excitatory pathway in the atrial endocardium. Which of the following areas should be avoided to leave the sinoatrial (pacemaker) node intact in this patient?
A
) Inferior to the opening of the coronary sinus
B
) The joining of the pulmonary vein and the left atrium
C
) The junction of the superior vena cava and the right atrium
D
) The opening of the inferior vena cava as it enters the right atrium
E
) Within the fossa ovalis

------------




thanks in advance

 

[drcuddles]

I am comparing my answers to what members have posted and i can say around 85% of my answers were correct yet I scored only 470= 222
That made me extremely depressed and postpone my exam 2 more weeks
Am actually scoring uworld 70% timed random
Can any1 suggest or help me in this regards
Many thanks

 

[omtj]

I am comparing my answers to what members have posted and i can say around 85% of my answers were correct yet I scored only 470= 222
That made me extremely depressed and postpone my exam 2 more weeks
Am actually scoring uworld 70% timed random
Can any1 suggest or help me in this regards
Many thanks

me too , i did it today and was under expectations > really confused !!

 

[674337]

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.

I picked D, Endometriosis and got it wrong. I think it's B, Endometrial Hyperplasia. The patient has excessive uterine bleeding at irregular intervals. My logic is that without the estrogen surge you lose the luteal phase which ultimately leads to the endometrium building up until a delayed menustration which will result in massive irregular bleeding.

 

[674337]

It is not Cervical Spinal Cord. I answered this and was wrong. Any help from anyone who got the question about tumor metastases right? I am thinking cerebellum.

I picked cerebellum and got it right.

 

[674337]

28 yr old female ,gravid 1 ,para 1 ,2 day h/o painful mass in right breast
delivered healthy newborn 3 wks ago and breastfeeding since then
temp-37 c
phy exam- 3 cm tender mass surrounded by erythema beneath areola,causal organism?

A.bacteriodes
B.e coli
C.haemophilus
D.STAPH a.
E.STREP. agalactiae

is it D. staph aureus?
p\overthinking lot

Acute mastitis... S. Aureus

 

[Nooda]

A pregnant women with abd pain for 12 hrs and upper quadrant pain. her labs show decreased platelets and hemoglobin and elevated liver enzymes. what would you expect on peripheral blood smear?
acanthocytes (wrong) I was thinking some liver disease
target cells
schistocytes >> I have seen people say this is the answer. But can you explain why ? what does she have ? DIC? even if so does it have RUQ pain ? or autoimmune hemolytic anemia or what

 

[Nooda]

yeah she also had 160/ 102 BP

 

[study for usmle nbme]

is it AS or AR? N pls explain coz theres no history of systemic HTN so hw do we conclude its AS or AR ..valve defect can be both n moreover age is favouring both..so i hw do u know what is it?

 

[study for usmle nbme]

A pregnant women with abd pain for 12 hrs and upper quadrant pain. her labs show decreased platelets and hemoglobin and elevated liver enzymes. what would you expect on peripheral blood smear?
acanthocytes (wrong) I was thinking some liver disease
target cells
schistocytes >> I have seen people say this is the answer. But can you explain why ? what does she have ? DIC? even if so does it have RUQ pain ? or autoimmune hemolytic anemia or what

of course shes having DIC ...its completely directing towars HELLP which is haemolytic ,elevated liver enzymes, low platelet .....coz of that haemolysis we will get schistocytes page 380 FA2014

 

[Nooda]

he is having AS because he is old his aortic valve should show calcification thus stenosis >> pressure overload >> concentric hypertrophy . And also because AR cause VOLUME overload (and pressure overload to some extent) this causes dilatation of the left ventricle which is not seen on the autopsy.

 

[mesho228]

hi everyone,
does anyone remembers the clinical trial Q ?
i cant remember the context.. any further info will be truly helpful.. thanks

 

[Moniiani]

Hi, I need some help please?!

1.during examination pt is asked to protruted his tongue and say Ah, cause elevation of the area of the tip, shown a picture , which nerve is tested: facial, hypoglossal, glossopharengeal, spinal accessory, vagus

2.angiogram of the left renal artery show area of area of stenosis and dilatation- string of beads sign- which is the cause: fibromuscular dysplasia, intimal fibroplasia,periarterial fibroplasia, perimedial hyperplasia

3.girl fainting while she is standing , BP 110/80 mmhg while suppine and 60 /40 mmhg while standing, undetectable level of NE and high DA, what is defficient : Monoamine oxidase, dopamine B - hydroxylase , NA transporter or AA decarboxylase

4.2 day itchy rash, widespread edematous and erhytematous rash with small vesicles on upper and lower extremities, which cells are activated: B lymphocytes, NK, Neutrophils, T lymphocytes

5.Administration of intravenous ibutilide- AE during next 6 hours- AV nodal reentry, sinus arrest, sinus tachycardia, Torsades des points

6.Pt with lung cancer that eat well and excersice but smoke, ask the physician how it is happening to him? Most apptopriate answer is?
Dont worry I'll be there, Eating right is not enough, it must be difficult to accepting dx when you feel healthy or regardless of your good habbits it time to realize that you have lung cancer

7.6 month Hx of joint pain poorly responsive to Tx with aspirin, bilateral swelling of proximal interphalangeal joints, metacarpophalangeal joints and wrists, few small nodules, around the joints- osteoarthritis or RA

8.Clinical trial for new drug - effect and toxicity-tested pharmacokinetics for first time- which phase of trial it is?

9.Pt with restrictive cardiomyopathy, renal failure and 35 years Hx of RA, renal biopsy show glomerular depostition of eosinophilic hyaline material that stain Congo red and show birefringent pattern under polarised light. Which of the following best explain staining features - helix-loop-helix , high hydroxyproline content, multiple dissulfide cross links, B-pleated sheet

10.Increased jugular venous pressure and middle ankle edema - cause ? Decrease plasma colloid osmotic pressure or ?

11.Study to assess the effect of Lidocaine injection in trigger points in pts with fibromyalgia , 50 % -receive saline, 50 % receive saline plus Lidocaine, shown graph, what is the cause of the results? Placebo effect, regression of the mean, type II error, uncontrolled confounding

12.Virulence factor of E.Coli that cause UTI- cytotoxin increase cellular concentratiom of c AMP , mannose binding fimbria, capsule composed of sialic acid, pyrogenic exotoxin

13. Serum - Na-143, K-3.2, CL-101, HCO3-11, Arterial blood gas analysis- PH-7,28, PCo2-23, PO2-98, what is the acid-base status of the pt?

14. Cause of three sysytemic infections with N.meningitidis for 2 year in a otherwise healthy 6 years old boy? Low Neutrophils, Low CD4-T-Lympho, Neutrophil myeloperoxidase concentration, total hemolytic complement concentration

Highly appreciate any help with this questions!!!!
Thank you

 

[RnaPolymerase2]

Hi, I need some help please?!

1.during examination pt is asked to protruted his tongue and say Ah, cause elevation of the area of the tip, shown a picture , which nerve is tested: facial, hypoglossal, glossopharengeal, spinal accessory, vagus
A. Vagus nerve innervate uvula and palate elevation

3.girl fainting while she is standing , BP 110/80 mmhg while suppine and 60 /40 mmhg while standing, undetectable level of NE and high DA, what is defficient : Monoamine oxidase, dopamine B - hydroxylase , NA transporter or AA decarboxylase
A. DopamineB hydroxylase (no Dopamine conversion to NE)

5.Administration of intravenous ibutilide- AE during next 6 hours- AV nodal reentry, sinus arrest, sinus tachycardia, Torsades des points

7.6 month Hx of joint pain poorly responsive to Tx with aspirin, bilateral swelling of proximal interphalangeal joints, metacarpophalangeal joints and wrists, few small nodules, around the joints- osteoarthritis or RA

8.Clinical trial for new drug - effect and toxicity-tested pharmacokinetics for first time- which phase of trial it is?
A. Phase. 1

9.Pt with restrictive cardiomyopathy, renal failure and 35 years Hx of RA, renal biopsy show glomerular depostition of eosinophilic hyaline material that stain Congo red and show birefringent pattern under polarised light. Which of the following best explain staining features - helix-loop-helix , high hydroxyproline content, multiple dissulfide cross links, B-pleated sheet

10.Increased jugular venous pressure and middle ankle edema - cause ? Decrease plasma colloid osmotic pressure or ?
Increased hydro static pressure.

12.Virulence factor of E.Coli that cause UTI- cytotoxin increase cellular concentratiom of c AMP , mannose binding fimbria, capsule composed of sialic acid, pyrogenic exotoxin

13. Serum - Na-143, K-3.2, CL-101, HCO3-11, Arterial blood gas analysis- PH-7,28, PCo2-23, PO2-98, what is the acid-base status of the pt?metabolic acidosis (normal Anion gap ) cos CL is high and compensation occurred low PCO2

14. Cause of three sysytemic infections with N.meningitidis for 2 year in a otherwise healthy 6 years old boy? Low Neutrophils, Low CD4-T-Lympho, Neutrophil myeloperoxidase concentration, total hemolytic complement concentration

Highly appreciate any help with this questions!!!!
Thank you

 

[Moniiani]

Thank you RnaPolymerase!!!!!! Thanks a lot!

 

[mulakosaag]

50 yr old man,with pins an needles sensation around mouth hands and feet
involuntary contractions of hand and feet -wrist flexion and plantar flexion
P-80/min BP- 150/90
mild hyperreflexia

which electrolyte abnormality ?

is it sodium?

nope it is Calcium =carpopedal sppasm D/t hypocalcemia

 

[mesho228]

hi everyone,
i remember there was a Q about sturvit stone may cause : atrophy or necrosis of the kidney ?
any help is highly appreciated. thaks

 

[RnaPolymerase2]

@Moniiani
Q2.angiogram of the left renal artery show area of area of stenosis and dilatation- string of beads sign- which is the cause: fibromuscular dysplasia, intimal fibroplasia,periarterial fibroplasia, perimedial hyperplasia

 

[2016togo]

there was a Q with a brain stem section and labeled structures .. i got it wrong i thought the answer is right MLF damage .. this is the Qstem

A 28-year-old woman is brought to the physician because of a 3-week history of double vision. One year ago, she had an episode of blurry vision in her left eye that gradually improved during the next 2 months without treatment. Neurologic examination shows that the right eye does not adduct past the midline on horizontal gaze when looking to the left. When convergence is tested, the right eye is able to adduct past the midline. Rightward horizontal gaze is normal. This patient most likely has a lesion involving which of the following labeled structures in the photograph of the brain stem shown?

i picked F , was wrong

MLF is anterior to the aqueduct and in the middle as its name implies. So the answer is C as I remember it.

---

10. A 50-year-old man who has smoked 2 packs of cigarettes a day for 34 years has experienced gradually increasing shortness of breath on exertion, chronic cough productive of thick sputum, and frequent episodes of wheezing. The anteroposterior diameter of his chest is increased. Diminished breath sounds and scattered rhonchi are audible throughout the lung fields. Which of the following laboratory abnormalities is expected?
A
) Decreased blood Pco2
B
) Increased blood HCO3−
C
) Increased blood pH
D
) Increased urinary excretion of HCO3−
E
) Increased urinary pH (picked this , was wrong)

for compensating respiratory acidosis
----
A 24-year-old man with a history of intravenous drug use is brought to the emergency department by his roommate 30 minutes after he could not be aroused. The friend reports that the patient injected himself with a drug approximately 6 hours ago. Laboratory studies show a serum drug concentration of 0.30 mg/L. Assuming the drug exhibits first-order one-compartment kinetics, has a half-life of2 hours, and a volume of distribution of 200 L in this patient, which of the following is the most likely approximate quantity of the drug (in mg) injected?
A
) 300
B
) 480
C
) 600
D
) 1000
E
) 1250

200*0.3*2*2*2 = 480

-----

44. A 58-year-old man with supraventricular tachyarrhythmia refractory to pharmacotherapy undergoes ablation of an accessory excitatory pathway in the atrial endocardium. Which of the following areas should be avoided to leave the sinoatrial (pacemaker) node intact in this patient?
A
) Inferior to the opening of the coronary sinus
B
) The joining of the pulmonary vein and the left atrium
C
) The junction of the superior vena cava and the right atrium
D
) The opening of the inferior vena cava as it enters the right atrium
E
) Within the fossa ovalis

------------




thanks in advance[/QUOTE]

 

[2016togo]

1.during examination pt is asked to protruted his tongue and say Ah, cause elevation of the area of the tip, shown a picture , which nerve is tested: facial, hypoglossal, glossopharengeal, spinal accessory, vagus

Vagus nerve for uvula

2.angiogram of the left renal artery show area of area of stenosis and dilatation- string of beads sign- which is the cause: fibromuscular dysplasia, intimal fibroplasia,periarterial fibroplasia, perimedial hyperplasia

fibromuscular dysplasia -> string of beads. its in 2015FA p.290 about hyertension.

3.girl fainting while she is standing , BP 110/80 mmhg while suppine and 60 /40 mmhg while standing, undetectable level of NE and high DA, what is defficient : Monoamine oxidase, dopamine B - hydroxylase , NA transporter or AA decarboxylase

dopamine hydroyxlase -> dopamine to NE

4.2 day itchy rash, widespread edematous and erhytematous rash with small vesicles on upper and lower extremities, which cells are activated: B lymphocytes, NK, Neutrophils, T lymphocytes

posion ivy questions? should be T lymphocyte then.

5.Administration of intravenous ibutilide- AE during next 6 hours- AV nodal reentry, sinus arrest, sinus tachycardia, Torsades des points

ibutilide -> class III -> torsades des points

6.Pt with lung cancer that eat well and excersice but smoke, ask the physician how it is happening to him? Most apptopriate answer is?
Dont worry I'll be there, Eating right is not enough, it must be difficult to accepting dx when you feel healthy or regardless of your good habbits it time to realize that you have lung cancer

Yes. it can be genetics and environmental.


7.6 month Hx of joint pain poorly responsive to Tx with aspirin, bilateral swelling of proximal interphalangeal joints, metacarpophalangeal joints and wrists, few small nodules, around the joints- osteoarthritis or RA

RA

8.Clinical trial for new drug - effect and toxicity-tested pharmacokinetics for first time- which phase of trial it is?

phase 1

9.Pt with restrictive cardiomyopathy, renal failure and 35 years Hx of RA, renal biopsy show glomerular depostition of eosinophilic hyaline material that stain Congo red and show birefringent pattern under polarised light. Which of the following best explain staining features - helix-loop-helix , high hydroxyproline content, multiple dissulfide cross links, B-pleated sheet

beta pleated sheet for amyloid

10.Increased jugular venous pressure and middle ankle edema - cause ? Decrease plasma colloid osmotic pressure or ?

hydro pressure

11.Study to assess the effect of Lidocaine injection in trigger points in pts with fibromyalgia , 50 % -receive saline, 50 % receive saline plus Lidocaine, shown graph, what is the cause of the results? Placebo effect, regression of the mean, type II error, uncontrolled confounding

placebo effect

12.Virulence factor of E.Coli that cause UTI- cytotoxin increase cellular concentratiom of c AMP , mannose binding fimbria, capsule composed of sialic acid, pyrogenic exotoxin

fimbriae

13. Serum - Na-143, K-3.2, CL-101, HCO3-11, Arterial blood gas analysis- PH-7,28, PCo2-23, PO2-98, what is the acid-base status of the pt?

metabolic acidosis

14. Cause of three sysytemic infections with N.meningitidis for 2 year in a otherwise healthy 6 years old boy? Low Neutrophils, Low CD4-T-Lympho, Neutrophil myeloperoxidase concentration, total hemolytic complement concentration

complement C5-C9 deficiency FA2015 p.206

Highly appreciate any help with this questions!!!!
Thank you[/QUOTE]

 

[2016togo]

50 yr old man,with pins an needles sensation around mouth hands and feet
involuntary contractions of hand and feet -wrist flexion and plantar flexion
P-80/min BP- 150/90
mild hyperreflexia

which electrolyte abnormality ?

is it sodium?

Think calcium when you see hyperreflexia.

 

[2016togo]

44 yr old woman
f/u for PAP smear of atypical squamous cells
molecular diag test presence of viral E6 protein of HPV
PROTEIN- PROMOTES CELL GROWTH AND MALIGNANCY BY CAUSING CELLULAR P53
protein degradation. This degradation most likely begins when p53 protein-targeted to which of the following types of cellular enzymes?

lysine acetyltransferase
lysosomal protease
serine protease
tyrosine kinase
ubiquitin ligase

I got this question right.
i think ubiquitin is like a tag for going to trash can to throw away the thing you dont want.

 

[mesho228]

if a pt came with symptoms of pericarditis, what to do next ? echo or EKG ?
this Q was not in NBME 17, but from somewhere else. plz help

 

[seminoma]

if a pt came with symptoms of pericarditis, what to do next ? echo or EKG ?
this Q was not in NBME 17, but from somewhere else. plz help

Neither. Need more info.

 

[doctor-mehr]

I picked G. Its not in my incorrects.

http://www.usmleforum.com/files/forum/2015/1/809078.php . here is a good explanation.

 

[g505]

no one is replying!?!

 

[g505]

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

I'm having a brain fart... can someone please clarify if the question is asking for the MOA of a drug that causes urinary retention or treats the urinary retention? thanks

 

[tvelocity514]

I'm having a brain fart... can someone please clarify if the question is asking for the MOA of a drug that causes urinary retention or treats the urinary retention? thanks

Drug that treats urinary urgency