USMLE NBME 18 - Questions and Answers - Discussions & Explanations

[TheAberrantGene]

NBME 18 has been released and is available on regular and extended feedback.
I will be taking it fairly soon as my exam is around the corner.
Let's continue the great trend on this forum and start a discussion once people start taking it,

Best of luck fellas !

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[WeedForLunch]

Fibrin. Perf'd diverticuli = poop in belly = tons of inflammation = fibrin.



I also got the AML question wrong...I'm now 90% sure the answer is histone acetylase. The giveaway is "pre-transcriptional complex," meaning histones need to be acetylated in order to start transcribing genes to differentiate the neoplastic cells.

The enzyme kinetics question answer is A. This is pretty straightforward biochemistry. Km is the substrate concentration required for an enzyme to reach 1/2 Vmax; higher Km means weaker substrate binding affinity- this rules out choices E and F, since those choices are backwards. Kcat is the the turnover constant- how much substrate can the enzyme chew through under max saturation. Higher Kcat = more enzymatic reactions per second. That rules out C and D, since these are also backwards. So now it's down to A and B; A is the obvious answer to what's causing this guys symptoms.

make it 100% sure... its acetylase.. got it right online..


Btw... how did this test feel to you as compared to other NBMEs ?
easier ? scored better ?

Thanks !

 

[Medic5522]

make it 100% sure... its acetylase.. got it right online..


Btw... how did this test feel to you as compared to other NBMEs ?
easier ? scored better ?

Thanks !

I did score better, but I thought it was the hardest one compared to to other two I've taken (15 and 17).

 

[WeedForLunch]

I did score better, but I thought it was the hardest one compared to to other two I've taken (15 and 17).

Thanks for that... if you dont mind could u tell me how much did u score in this one as compared to the other 2... i ask because i scored much higher in this one as compared to the ones i have taken thus far and hence do not know what to make of this as it seems over predictive

 

[vulnificus]

Section 1 item 47: child with XXY karyotype, genetic studies showed he received the extra "x" from his father. an error of chromosome segregation occurred during anaphase at which of the following stages of spermatogenesis in the patient's father?
a- early spermatid
b- late spermatid
c- 1ry spermatocyte
d- primordial germ cell
e- 2ry spermatocyte
f- spermatozoan

section 2 item 7:
a transcription factor that activates expression of HMG coA reductase is identified, this TF is initially synthetized as a large precursor protein, with 2 membrane spanning domains. the transcriptional domain is released by proteolysis when the membrane has a decreased cholesterol concentration. the precursor protein is mot likely initially produced in which of the following labeled area on this labeled diagram of a hepatocyte?
then there's a diagram that points to different organelles:
a- nucleus
b- mitochondria
c- cytoplasm (I chose this, it's WRONG, my rationale was that free ribosomes aka "not attached to RER" can produce proteins)
d- ER
e- golgi
f- lysosome

can someone please explain this? i think it's ER but not sure

 

[vulnificus]

Don't overthink! It can destroy your score even if you have a sound knowledge base. I do it too! The answers I got wrong are so silly that even I am judging myself. lol

I scored 2 points lower in 18 than my last nbme. I have only taken one other.
Nbme 17 -249(3weeks ago)
Nbm2 18- 247(2 days ago)

I have 3 weeks left till my exam. Can you give me any pointers on how to study? I want to break 250.

I am in the same exact situation as you:

NBME17: 249 (2 weeks ago)
NBME 18: 245 (today)
I got very upset coz i did most of kaplan qbank in those 2 weeks, also did a lot of UW incorrect Qs, it's very frustrating.
Is it just me or nbme 18 is a lot harder than 17?
any recommendations for the next 10 days?

 

[AnxietyAnnie]

make it 100% sure... its acetylase.. got it right online..


Btw... how did this test feel to you as compared to other NBMEs ?
easier ? scored better ?

Thanks !

Section 1 item 47: child with XXY karyotype, genetic studies showed he received the extra "x" from his father. an error of chromosome segregation occurred during anaphase at which of the following stages of spermatogenesis in the patient's father?
a- early spermatid
b- late spermatid
c- 1ry spermatocyte
d- primordial germ cell
e- 2ry spermatocyte
f- spermatozoan

section 2 item 7:
a transcription factor that activates expression of HMG coA reductase is identified, this TF is initially synthetized as a large precursor protein, with 2 membrane spanning domains. the transcriptional domain is released by proteolysis when the membrane has a decreased cholesterol concentration. the precursor protein is mot likely initially produced in which of the following labeled area on this labeled diagram of a hepatocyte?
then there's a diagram that points to different organelles:
a- nucleus
b- mitochondria
c- cytoplasm (I chose this, it's WRONG, my rationale was that free ribosomes aka "not attached to RER" can produce proteins)
d- ER
e- golgi
f- lysosome

can someone please explain this? i think it's ER but not sure

C-Primary spermatocyte (segregation of X and Y occurs at the end of Meiosis 1)
D-ER
I got these right.

For D my rationale was that since steroid hormones are produced by ER and cholesterol is their precursor, it should be ER. It worked. The labelled structure was RER.

 

[AnxietyAnnie]

I am in the same exact situation as you:

NBME17: 249 (2 weeks ago)
NBME 18: 245 (today)
I got very upset coz i did most of kaplan qbank in those 2 weeks, also did a lot of UW incorrect Qs, it's very frustrating.
Is it just me or nbme 18 is a lot harder than 17?
any recommendations for the next 10 days?

NBME18 was harder than 17, no doubt. But I feel, my score drop had something to do with the fact that I was very nervous taking it since it had just come out a few days ago. I got some very silly ones wrong. I plan to do FA and Uworld system wise in the last days and I am saving form 16 for the end. I really want to break 250 :/. @vulnificus

 

[Medic5522]

Thanks for that... if you dont mind could u tell me how much did u score in this one as compared to the other 2... i ask because i scored much higher in this one as compared to the ones i have taken thus far and hence do not know what to make of this as it seems over predictive

Form 17 gave me a scaled high 230s...can't remember exactly. 18 gave me a scaled 261.

 

[Medic5522]

C-Primary spermatocyte (segregation of X and Y occurs at the end of Meiosis 1)
D-ER
I got these right.

For D my rationale was that since steroid hormones are produced by ER and cholesterol is their precursor, it should be ER. It worked. The labelled structure was RER.

Any proteins destined for places other than the cytosol are synthesized in the RER and then trafficked by the secretory system to wherever they want to do. Since it's a transmembrane protein, it's made in the RER.

 

[TheNsg300]

Just got done with it today. It was pretty fair (had 8 incorrect/271) hoping the actual exam is anything as close. Couldn't come up with the explanation with the ethics question where 2 year old girl presents to the ER after having a febrile seizure at day care and apparently no parent around for consent for antibiotics or LP. I went with giving Antibiotics and waiting for consent for the LP, was wrong!! Whats your guys take on it??

 

[WeedForLunch]

Form 17 gave me a scaled high 230s...can't remember exactly. 18 gave me a scaled 261.

thanks for that... approx how long ago was 17 coz it impacts the inference we can derive.. i mean if u studied tons of stuff in between then the 261 may be justified...else it could be just that 18 is overpredictive.

thanks agin for the response

 

[WeedForLunch]

C-Primary spermatocyte (segregation of X and Y occurs at the end of Meiosis 1)
D-ER
I got these right.

For D my rationale was that since steroid hormones are produced by ER and cholesterol is their precursor, it should be ER. It worked. The labelled structure was RER.

its ER was right online

 

[vulnificus]

Any proteins destined for places other than the cytosol are synthesized in the RER and then trafficked by the secretory system to wherever they want to do. Since it's a transmembrane protein, it's made in the RER.

but the thing is, the question is asking about the site of synthesis of the transcription factor of hmg coA reducatse

 

[AnxietyAnnie]

but the thing is, the question is asking about the site of synthesis of the transcription factor of hmg coA reducatse

that TF is a "large precursor protein" and it has to go inside the nucleus(outside of cytosol) eventually to increase expression of HMG coA reductase . Medic5522 is right here.

 

[breadlover72]

Just got done with it today. It was pretty fair (had 8 incorrect) hoping the actual exam is anything as close. Couldn't come up with the explanation with the ethics question where 2 year old girl presents to the ER after having a febrile seizure at day care and apparently no parent around for consent for antibiotics or LP. I went with giving Antibiotics and waiting for consent for the LP, was wrong!! Whats your guys take on it??

Proceeding with treatment and LP. Anytime there's a life threatening condition (meningitis in this case, which is what I would consider life threatening in a kid) you can bypass parental consent and treat the minor.

 

[vulnificus]

section 3 q6:
45 yr old man with SOB on exertion x 6 months, nosebleeds since adolescence, 2 pics: clubbing + hemorrhagic lesions in tongue, inhaled albuterol doesn't improve his symptoms
cause of symptoms?
a- ASD (wrong)
b- HTN
c- Pulmonary AV shunting
d- reactive airway disease
e- thromboembolism

is it C? is this alpha 1 AT deficiency? what are those tongue lesions?

section 1 q33
patient making sexual advances on doctor:
a- have a chaperone join them
b- interrupt the pt with a more neutral topic
c- tell the patient it is common for patients to fantasize about physicians (wrong)

section 3 q20
pt with celiac disease, which cells are dysfunctional?
a- enterocytes
b- goblet
c- paneth (wrong, i thought paneth cells mistake gluten molecules for antigens and trigger an immune reaction?)


section 4 q5
35 yr man with severe back pain, gained 8 kgs in the past 6 mos, decreased peripheral vision, compression fracture spine, imaging shows pituitary macroadenoma, this tumor produces what?
Acth, gh, lh, prolactin, tsh?

 

[TheNsg300]

I got this one right so... it was whatever the choice was about proceeding with treatment and LP. Anytime there's a life threatening condition (meningitis in this case, which is what I would consider life threatening in a kid) you can bypass parental consent and treat the minor.

I thought so too intially, but I thought the LP can wait as long as the patient received the antibiotics, wasn't a life saving procedure. Had a similar case in Khan's medical cases but the answer was different. Anyways thanks for the input!

 

[TheNsg300]

section 3 q6:
45 yr old man with SOB on exertion x 6 months, nosebleeds since adolescence, 2 pics: clubbing + hemorrhagic lesions in tongue, inhaled albuterol doesn't improve his symptoms
cause of symptoms?
a- ASD (wrong)
b- HTN
c- Pulmonary AV shunting
d- reactive airway disease
e- thromboembolism

is it C? is this alpha 1 AT deficiency? what are those tongue lesions?

section 1 q33
patient making sexual advances on doctor:
a- have a chaperone join them
b- interrupt the pt with a more neutral topic
c- tell the patient it is common for patients to fantasize about physicians (wrong)

section 3 q20
pt with celiac disease, which cells are dysfunctional?
a- enterocytes
b- goblet
c- paneth (wrong, i thought paneth cells mistake gluten molecules for antigens and trigger an immune reaction?)


section 4 q5
35 yr man with severe back pain, gained 8 kgs in the past 6 mos, decreased peripheral vision, compression fracture spine, imaging shows pituitary macroadenoma, this tumor produces what?
Acth, gh, lh, prolactin, tsh?

1. C:Hereditary hemorrhagic telangiectasia (osler-weber-rendau sx)
2. A
3. A
4. A

 

[breadlover72]

I thought so too, but I thought the LP can wait as long as the patient received the antibiotics, wasn't a life saving procedure. Had a similar case in Khan's medical cases but the answer was different. Anyways thanks for the input!

No problem. My thought process was meningococcal meningitis which has a high fatality rate, technically need to do an LP or get any type of cultures before you start IV antibiotics usually.

 

[vulnificus]

I thought so too, but I thought the LP can wait as long as the patient received the antibiotics, wasn't a life saving procedure. Had a similar case in Khan's medical cases but the answer was different. Anyways thanks for the input!

the one in khan was a child with a broken arm but it clearly said the nerves and vessels were intact so it wasn;t an emergency, whereas here delaying treatment of meningitis could be catastrophic, and i believe that giving antibiotics unguided by csf analysis isn't the best move

 

[vulnificus]

Thank you very much for your replies guys.

4 yr male with recurrent UTIs, left kidney found small and non functional, nephrectomy done, picture shown
a- diffuse cortical necr
b- fibromuscular dysplasia
c- neoplastic
d- thing GBM (wrong)
e- tubular atrophy

was this PUJO with hydronephrosis and eventual atrophy? if yes, what's the pthological change?

 

[vulnificus]

section 4 q50
target cells post splenectomy, due to loss of function of?
a- endoth cells of cortex
b- germinal centers
c- perivascular lympho
d- red pulp
e- splenic connective tissue

 

[TheNsg300]

section 4 q50
target cells post splenectomy, due to loss of function of?
a- endoth cells of cortex
b- germinal centers
c- perivascular lympho
d- red pulp
e- splenic connective tissue

Should be E and D respectively!

 

[myeloma71]

A 67-year-old woman comes to the physician because of a 1-month history of low back pain. She has hypertension well controlled with a thiazide diuretic. Her pulse is 140/min, and blood pressure is 140/85 mm Hg. Physical examination shows tenderness to palpation over the L2-3 vertebrae. Laboratory studies show:
Hemoglobin 13.5 g/dL
Hematocrit 41%
Leukocyte count 10,500/mm3
Segmented neutrophils 65%
Eosinophils 1%
Basophils 1%
Lymphocytes 30%
Monocytes 3%
Platelet count 250,000/mm3

Serum electrophoresis shows a monoclonal spike of IgG kappa. A chest x-ray shows cardiomegaly with bilateral pleural and pericardial effusions. An x-ray of the spine shows a lytic lesion. Echocardiography shows an echodense thickened left ventricle and poor diastolic compliance. A photomicrograph of a specimen obtained on myocardial biopsy is shown. Which of the following is the most likely cause of the cardiac findings in this patient?
A
) Acute infarction
B
) Acute myocarditis
C
) Amyloid infiltration
D
) Cardiomyopathy
E
) Plasma cell infiltration

 

[vulnificus]

A 67-year-old woman comes to the physician because of a 1-month history of low back pain. She has hypertension well controlled with a thiazide diuretic. Her pulse is 140/min, and blood pressure is 140/85 mm Hg. Physical examination shows tenderness to palpation over the L2-3 vertebrae. Laboratory studies show:
Hemoglobin 13.5 g/dL
Hematocrit 41%
Leukocyte count 10,500/mm3
Segmented neutrophils 65%
Eosinophils 1%
Basophils 1%
Lymphocytes 30%
Monocytes 3%
Platelet count 250,000/mm3

Serum electrophoresis shows a monoclonal spike of IgG kappa. A chest x-ray shows cardiomegaly with bilateral pleural and pericardial effusions. An x-ray of the spine shows a lytic lesion. Echocardiography shows an echodense thickened left ventricle and poor diastolic compliance. A photomicrograph of a specimen obtained on myocardial biopsy is shown. Which of the following is the most likely cause of the cardiac findings in this patient?
A
) Acute infarction
B
) Acute myocarditis
C
) Amyloid infiltration
D
) Cardiomyopathy
E
) Plasma cell infiltration

she has MM so the answer is C (Ig Light chain infiltrate the heart)

 

[myeloma71]

she has MM so the answer is C (Ig Light chain infiltrate the heart)

Thanks. I mixed it up with amyloid--> restrictive cardiomyopathy

 

[myeloma71]

couple of questions coming up..


A 72-year-old woman comes to the physician because of a 6-month history of increased bruising on her forearms. She appears alert and well nourished. Physical examination shows extensive wrinkling, scaly erythematous patches on the face, and irregularly shaped brown macules on the face and forearms. There are ecchymoses in various stages of healing on both forearms; the ecchymoses are more numerous on the right side. Laboratory studies, including a complete blood count and coagulation studies, are within the reference ranges. She has noticed no bleeding from her gums after brushing her teeth. Which of the following is the most likely cause of the ecchymoses in this patient?
A
) Exocytosis of lymphocytes
B
) Extensive solar elastosis
C
) Impaired platelet function
D
) Ultraviolet destruction of Langerhans cells in the epidermis

A 22-year-old man who is a professional cyclist undergoes extensive physiologic testing as part of his training regimen. His resting pulse is 33/min, and blood pressure is110/62 mm Hg. Echocardiography shows dilated ventricles with normal function and a left ventricular ejection fraction of 75%. Which of the following best describes the findings in this patient?
A
) Congestive cardiomyopathy
B
) Diastolic dysfunction
C
) Eccentric hypertrophy
D
) Hypertrophic cardiomyopathy
E
) Increased myocardial stiffness




A 30-year-old woman with a long-standing history of pelvic inflammatory disease has surgical resection of a scarred segment of a fallopian tube. Which of the following inflammatory cells is most likely to be found in the resected specimen?
A
) Basophils
B
) Eosinophils
C
) Macrophages
D
) Mast cells
E
) Neutrophils


A 25-year-old man is admitted to the hospital because of severe crush injuries to the chest and extensive burns over 30% of his body surface area. Three hours later, he develops tachypnea and dyspnea. Arterial blood gas analysis on room air shows a decreased Po2 and Pco2. A chest x-ray shows bilateral interstitial and alveolar infiltrates. The patient is intubated and mechanically ventilated. Damage to which of the following is most likely to preclude restoration of normal tissue architecture and pulmonary function in this patient?
A
) Basement membranes
B
) Capillaries
C
) Fibroblasts
D
) Macrophages
E
) Mast cells
F
) Type I pneumocytes

A 65-year-old woman comes to the physician because of a 1-week history of a swollen, painful left knee. Her temperature is 38°C (100.4°F), and blood pressure is 110/65 mm Hg. Examination of the left knee shows erythema and swelling of the joint and decreased range of motion. A photomicrograph of synovial fluid obtained by arthrocentesis is shown. This patient's synovial fluid most likely contains which of the following?
A
) Hydroxyapatite
B
) Lymphocytes
C
) Neisseria gonorrhoeae
D
) Treponema pallidum
E
) Uric acid

 

[AnxietyAnnie]

couple of questions coming up..


A 72-year-old woman comes to the physician because of a 6-month history of increased bruising on her forearms. She appears alert and well nourished. Physical examination shows extensive wrinkling, scaly erythematous patches on the face, and irregularly shaped brown macules on the face and forearms. There are ecchymoses in various stages of healing on both forearms; the ecchymoses are more numerous on the right side. Laboratory studies, including a complete blood count and coagulation studies, are within the reference ranges. She has noticed no bleeding from her gums after brushing her teeth. Which of the following is the most likely cause of the ecchymoses in this patient?
A
) Exocytosis of lymphocytes
B
) Extensive solar elastosis
C
) Impaired platelet function
D
) Ultraviolet destruction of Langerhans cells in the epidermis

A 22-year-old man who is a professional cyclist undergoes extensive physiologic testing as part of his training regimen. His resting pulse is 33/min, and blood pressure is110/62 mm Hg. Echocardiography shows dilated ventricles with normal function and a left ventricular ejection fraction of 75%. Which of the following best describes the findings in this patient?
A
) Congestive cardiomyopathy
B
) Diastolic dysfunction
C
) Eccentric hypertrophy
D
) Hypertrophic cardiomyopathy
E
) Increased myocardial stiffness




A 30-year-old woman with a long-standing history of pelvic inflammatory disease has surgical resection of a scarred segment of a fallopian tube. Which of the following inflammatory cells is most likely to be found in the resected specimen?
A
) Basophils
B
) Eosinophils
C
) Macrophages
D
) Mast cells
E
) Neutrophils


A 25-year-old man is admitted to the hospital because of severe crush injuries to the chest and extensive burns over 30% of his body surface area. Three hours later, he develops tachypnea and dyspnea. Arterial blood gas analysis on room air shows a decreased Po2 and Pco2. A chest x-ray shows bilateral interstitial and alveolar infiltrates. The patient is intubated and mechanically ventilated. Damage to which of the following is most likely to preclude restoration of normal tissue architecture and pulmonary function in this patient?
A
) Basement membranes
B
) Capillaries
C
) Fibroblasts
D
) Macrophages
E
) Mast cells
F
) Type I pneumocytes

A 65-year-old woman comes to the physician because of a 1-week history of a swollen, painful left knee. Her temperature is 38°C (100.4°F), and blood pressure is 110/65 mm Hg. Examination of the left knee shows erythema and swelling of the joint and decreased range of motion. A photomicrograph of synovial fluid obtained by arthrocentesis is shown. This patient's synovial fluid most likely contains which of the following?
A
) Hydroxyapatite
B
) Lymphocytes
C
) Neisseria gonorrhoeae
D
) Treponema pallidum
E
) Uric acid

B-Extensive solar elastosis
C-Eccentric hypertrophy
A-Basement membranes
E-Uric acid

 

[WeedForLunch]

Thanks. I mixed it up with amyloid--> restrictive cardiomyopathy

This was the shi*tiest question ever...
Wasn't this like maybe the last on the 4th block or something ?

I think it is inappropriate that they would give us a question with 2 correct answers.... Amyloid deposition leads to Cardiomyopathy and hence 2 answers are right...
I got it wrong just like u :-(

 

[myeloma71]

B-Extensive solar elastosis
C-Eccentric hypertrophy
A-Basement membranes
E-Uric acid

Thank you so much !
I need to check up on solar elastosis didnt come across it in FA
Wouldn't eccentric hypertrophy occur in systolic dysfunction which causes a decreased EF ?
Could you elaborate a bit on basement membrane ? I thought type 2 pneumocytes would be the answer which wasnt even an option
Yes uric acid makes sense but i was under the impression that you see both yellow and blue crystals.

 

[myeloma71]

This was the shi*tiest question ever...
Wasn't this like maybe the last on the 4th block or something ?

I think it is inappropriate that they would give us a question with 2 correct answers.... Amyloid deposition leads to Cardiomyopathy and hence 2 answers are right...
I got it wrong just like u :-(

second block i think. yes thats exactly what i thought !

 

[AnxietyAnnie]

B-Extensive solar elastosis
C-Eccentric hypertrophy
A-Basement membranes
E-Uric acid

1.I got the solar elastosis q wrong too. I don't know where that came from.
2. That patient was a prof. cyclist and athletes are known to have eccentric hypertrophy due to functional volume overload as the skeletal muscles (soleus) act as pumps to increase venous return. It is not pathological.
3. I understand how type 2 pneumos can act as stemcells for type 1 but overall the integrity of basement membrane would direct type 2s to ensure a normal restoration. ( I think a similar mechanism works for skin too. You only get a scar if the bm has been breached otherwise the skin regenerates normally without a scar)
4. The synovial fluid analysis picture was a regular one with a gaint uric acid crystal. It was not taken under polarized light.

 

[myeloma71]

1.I got the solar elastosis q wrong too. I don't know where that came from.
2. That patient was a prof. cyclist and athletes are known to have eccentric hypertrophy due to functional volume overload as the skeletal muscles (soleus) act as pumps to increase venous return. It is not pathological.
3. I understand how type 2 pneumos can act as stemcells for type 1 but overall the integrity of basement membrane would direct type 2s to ensure a normal restoration. ( I think a similar mechanism works for skin too. You only get a scar if the bm has been breached otherwise the skin regenerates normally without a scar)
4. The synovial fluid analysis picture was a regular one with a gaint uric acid crystal. It was not taken under polarized light.

Aaahh thanks a ton !

 

[vulnificus]

second block i think. yes thats exactly what i thought !

@WeedForLunch i perfectly understand where you guys are coming from as i was choosing between those 2 answers too. but i thought that amyloid infiltration is a lot more specific than just "cardiomyopathy" without even specifying which type. but i agree, they are evil hahaha.

@AnxietyAnnie wasn't there a similar question about lung Basement membrane in nbme 17?

 

[breadlover72]

1.I got the solar elastosis q wrong too. I don't know where that came from.

This was terrible. Apparently describing actinic keratosis... which includes dermal solar elastosis in its histological features. I missed it too.
(http://emedicine.medscape.com/article/1976538-overview#a1)

 

[AnxietyAnnie]

@WeedForLunch i perfectly understand where you guys are coming from as i was choosing between those 2 answers too. but i thought that amyloid infiltration is a lot more specific than just "cardiomyopathy" without even specifying which type. but i agree, they are evil hahaha.

@AnxietyAnnie wasn't there a similar question about lung Basement membrane in nbme 17?

@vulnificus Yep, there was. Didn't mention on purpose. Spoiler alert! ^__^

 

[vulnificus]

did anyone else notice there were 2 ethics questions where the correct answer was "refer to support groups"?
i got them right but the knee jerk reflex is to not refer the patient and try to deal with him yourself. but i think they're trying to propagate the concepts of support groups. what do you guys think about that?
@AnxietyAnnie @WeedForLunch @myeloma71 @TheNsg300

 

[breadlover72]

did anyone else notice there were 2 ethics questions where the correct answer was "refer to support groups"?
i got them right but the knee jerk reflex is to not refer the patient and try to deal with him yourself. but i think they're trying to propagate the concepts of support groups. what do you guys think about that?

I guess these were to encourage compliance which usually includes peer groups (I'm used to seeing it for teen scenarios though) I thought it was a little weird though cause as you said they always encourage the physician to address it first with "tell me more," having them elaborate, or giving some supportive statement.

 

[AnxietyAnnie]

did anyone else notice there were 2 ethics questions where the correct answer was "refer to support groups"?
i got them right but the knee jerk reflex is to not refer the patient and try to deal with him yourself. but i think they're trying to propagate the concepts of support groups. what do you guys think about that?
@AnxietyAnnie @WeedForLunch @myeloma71 @TheNsg300

@vulnificus Thanks to all those correct "refer to support group" questions, I ended up sending the 29yr old PCOS lady to a support group too and got it wrong. What was the correct answer there? Tell her about the consequences if she doesn't comply? What is the correct way to reinforce compliance in each age group? Any useful tables? (I only know about peer support for teens)

@breadlover72 Thanks for the solar elastosis link.

 

[vulnificus]

@vulnificus Thanks to all those correct "refer to support group" questions, I ended up sending the 29yr old PCOS lady to a support group too and got it wrong. What was the correct answer there? Tell her about the consequences if she doesn't comply? What is the correct way to reinforce compliance in each age group? Any useful tables? (I only know about peer support for teens)

@breadlover72 Thanks for the solar elastosis link.

wait a sec, i thought the PCOS case that was the correct answer. can you post this question with the answers again plz?

 

[AnxietyAnnie]

wait a sec, i thought the PCOS case that was the correct answer. can you post this question with the answers again plz?

A 29yr old woman comes to the physician because of irregular menstrual periods since menarche at the age of 12. She is 5.3Ft and weighs 86kgs. BMI 34. She is evaluated and a diagnosis of PCOS is made. After explaining the diagnosis, the physician discusses behavioral changes, including dietary modification and exercise as part of her treatment. Which of the following will ensure adherence?
A. Ascertain the patient's education and provide publications
B. Ask the patient to bring a friend or family member to next visit
C Inform the patient of health consquences of not treating her condition
D Provide follow ups to monitor progress in attaining her goal
E Refer to a support group

@vulnificus

 

[breadlover72]

A 29yr old woman comes to the physician because of irregular menstrual periods since menarche at the age of 12. She is 5.3Ft and weighs 86kgs. BMI 34. She is evaluated and a diagnosis of PCOS is made. After explaining the diagnosis, the physician discusses behavioral changes, including dietary modification and exercise as part of her treatment. Which of the following will ensure adherence?
A. Ascertain the patient's education and provide publications
B. Ask the patient to bring a friend or family member to next visit
C Inform the patient of health consquences of not treating her condition
D Provide follow ups to monitor progress in attaining her goal
E Refer to a support group

@vulnificus

I couldn't remember the specifics of this one until now. This one was follow ups to monitor progress. I don't have a great explanation, I didn't like the other choices and I figured showing support by setting a follow up appointment will motivate the patient towards meeting whatever goal.

 

[breadlover72]

Can anyone please explain the orthostatic hypotension, loose stools for 1 year (hx of type 1 DM) pathophysiological mechanism of the diarrhea? It's driving me insane and I feel like I'm missing something completely. Secretion, osmosis (wrong), motility disorder, generalized malabsorption, or exudation?

 

[AnxietyAnnie]

Can anyone please explain the orthostatic hypotension, loose stools for 1 year (hx of type 1 DM) pathophysiological mechanism of the diarrhea? It's driving me insane and I feel like I'm missing something completely. Secretion, osmosis (wrong), motility disorder, generalized malabsorption, or exudation?

@breadlover72

Longtime diabetes causing autonomic neuropathy----> motility disorder.

 

[breadlover72]

@breadlover72

Longtime diabetes causing autonomic neuropathy----> motility disorder.

Ugh, thank you...I was leaning towards that but with neuropathy I figured if it were motility then they'd be constipated.

 

[vulnificus]

A 29yr old woman comes to the physician because of irregular menstrual periods since menarche at the age of 12. She is 5.3Ft and weighs 86kgs. BMI 34. She is evaluated and a diagnosis of PCOS is made. After explaining the diagnosis, the physician discusses behavioral changes, including dietary modification and exercise as part of her treatment. Which of the following will ensure adherence?
A. Ascertain the patient's education and provide publications
B. Ask the patient to bring a friend or family member to next visit
C Inform the patient of health consquences of not treating her condition
D Provide follow ups to monitor progress in attaining her goal
E Refer to a support group

@vulnificus

I believe the difference between this one and the SLE one is that here, the physician provided a concrete set of recommendations to the patient aka wt loss and exercise, so since he provided those, it makes sense that he would follow up. besides, the question is specifically asking about "what will improve adherence"

 

[myeloma71]

couple of more questions and im done.. thanks in advance guys !


A 68-year-old man comes to the physician because of a 1-month history of light-headedness and tightness in his chest with exertion. He adds that the pain is worse after arguing with his wife, and the symptoms resolve with rest. He has a past history of lower gastrointestinal bleeding; evaluation at that time was negative on upper endoscopy and colonoscopy. His temperature is 37°C (98.6°F), pulse is 85/min, respirations are 15/min, and blood pressure is 110/75 mm Hg. Physical examination shows no abnormalities. His hemoglobin concentration is 8.2 g/dL, and hematocrit is 24%. Test of the stool for occult blood is positive. An ECG shows no abnormalities. Repeat colonoscopy shows no abnormalities. Which of the following is the most likely cause of this patient's gastrointestinal symptoms?
A
) Adenocarcinoma of the colon
B
) Angiodysplasia
C
) Diverticulitis
D
) Peutz-Jeghers syndrome
E
) Ulcerative colitis


A 70-year-old woman comes to the physician for a routine pelvic examination. During speculum examination of the vagina and cervix, the Valsalva maneuver causes a bulge of the anterior vaginal wall. Which of the following is the most likely cause of this finding?
A
) Bartholin gland cyst
B
) Cystocele
C
) Obturator hernia
D
) Rectocele
E
) Uterine prolapse


A 25-year-old woman comes to the physician because of a 2-year history of intermittent, diffuse, cramping lower abdominal pain. The pain is usually associated with2 to 6 days of loose, watery stools, and is typically relieved with defecation. Between these episodes, her stools are normal. Her vital signs are within normal limits. Physical examination shows no abnormalities. Laboratory studies, including complete blood count, metabolic panel, and thyroid function tests show no abnormalities. A drug targeting which of the following mechanisms of action is most appropriate for this patient?
A
) Accentuation of bile salt reabsorption
B
) Accentuation of μ-opioid myenteric plexus receptor
C
) Inhibition of colonic water reabsorption
D
) Inhibition of 5-hydroxytryptamine 1 receptor
E
) Inhibition of tumor necrosis factor-α

 

[breadlover72]

couple of more questions and im done.. thanks in advance guys !


A 68-year-old man comes to the physician because of a 1-month history of light-headedness and tightness in his chest with exertion. He adds that the pain is worse after arguing with his wife, and the symptoms resolve with rest. He has a past history of lower gastrointestinal bleeding; evaluation at that time was negative on upper endoscopy and colonoscopy. His temperature is 37°C (98.6°F), pulse is 85/min, respirations are 15/min, and blood pressure is 110/75 mm Hg. Physical examination shows no abnormalities. His hemoglobin concentration is 8.2 g/dL, and hematocrit is 24%. Test of the stool for occult blood is positive. An ECG shows no abnormalities. Repeat colonoscopy shows no abnormalities. Which of the following is the most likely cause of this patient's gastrointestinal symptoms?
A
) Adenocarcinoma of the colon
B
) Angiodysplasia
C
) Diverticulitis
D
) Peutz-Jeghers syndrome
E
) Ulcerative colitis


A 70-year-old woman comes to the physician for a routine pelvic examination. During speculum examination of the vagina and cervix, the Valsalva maneuver causes a bulge of the anterior vaginal wall. Which of the following is the most likely cause of this finding?
A
) Bartholin gland cyst
B
) Cystocele
C
) Obturator hernia
D
) Rectocele
E
) Uterine prolapse


A 25-year-old woman comes to the physician because of a 2-year history of intermittent, diffuse, cramping lower abdominal pain. The pain is usually associated with2 to 6 days of loose, watery stools, and is typically relieved with defecation. Between these episodes, her stools are normal. Her vital signs are within normal limits. Physical examination shows no abnormalities. Laboratory studies, including complete blood count, metabolic panel, and thyroid function tests show no abnormalities. A drug targeting which of the following mechanisms of action is most appropriate for this patient?
A
) Accentuation of bile salt reabsorption
B
) Accentuation of μ-opioid myenteric plexus receptor
C
) Inhibition of colonic water reabsorption
D
) Inhibition of 5-hydroxytryptamine 1 receptor
E
) Inhibition of tumor necrosis factor-α

B, B, & B... when all else fails I guess choose B.

 

[usmle2016]

Please help, thanks in advance guys!
1.A 71-year old woman with coronary disease and well-controled hypertension is brought to the physician 2 hours after sudden onset of weakness of her left leg.Her BP 145/85 mmHg. Neurologic exam: weakness and decreased sensation over the left lower extremity. There are no other sensory or motor deficits. Which labeled structure is site of injury?

B(incorrect)(I thought it was pure thalamus motor and sensory stroke,but wrong)

2.A 34-year-old man with a 3 month history of a progressive rash on his feet. The rash is not ithchy or painful. A photogtaph of feet is shown. HIV+. In addition to HAART, which of the following pharmacotherapy is most appropriate?
A Antibacterial(incorrect)(I thought it was Kaposi sarcoma, but no other antiviral drug can choose, so I consider bacillary angiomatosis,which also in HIV patients, so I chose A)
B Antifungal
C Antihistaminic
D Antineoplastic(is this correct answer? since Kaposi sarcoma is also a tumor. But how to distinguish Kaposi with bacillary angiomatosis,I googled the pictures of these two disease nearly look the same)
E Antiparasitic

3.Give lovastatin, this treatment would result in which adaptive responses at cellular level?
A decreased hepatic expression of LDL-cholesterol receptors
B decreased transcription of HMG-CoA reductase(incorrect)
C increased mevalonic acid degradation
D increased mevalonic acid synthesis
E increased transcription of HMG-CoA reductase

4.A 68-year-old man with a 10-month history of shortness of breath and sweeling of his feet, family history of cardiovascular disease. He smoked 2 packs of cigarettes daily for 50 years. Puse 80/min, respirations 24/min, BP 150/80 mmHg. PE: 3+pitting edema of lower extremities. Diffuse, scattered wheezes are heard bilaterally on auscultation of the chest. Grade 2/6 pansystolic mumur heard best at lower left sternal border, which increases on inspiration. Maximal impulse palpated in sub-xiphoid area. S1 and S2 sounds are distant. Liver span 14cm. Diagnosis?
A Aortic stenosis
B Cardiac amyloidosis(incorrect)
C Cor pulmonale
D Coronary artery disease
E Primary pulmonary hypertension
Not have a clue, especially about the last 2 questions. Would anyone please give an explantion for me? Thanks a lot!

 

[throwawaysocket2016]

Please help, thanks in advance guys!
1.A 71-year old woman with coronary disease and well-controled hypertension is brought to the physician 2 hours after sudden onset of weakness of her left leg.Her BP 145/85 mmHg. Neurologic exam: weakness and decreased sensation over the left lower extremity. There are no other sensory or motor deficits. Which labeled structure is site of injury?
View attachment 201250
B(incorrect)(I thought it was pure thalamus motor and sensory stroke,but wrong)

2.A 34-year-old man with a 3 month history of a progressive rash on his feet. The rash is not ithchy or painful. A photogtaph of feet is shown. HIV+. In addition to HAART, which of the following pharmacotherapy is most appropriate?
A Antibacterial(incorrect)(I thought it was Kaposi sarcoma, but no other antiviral drug can choose, so I consider bacillary angiomatosis,which also in HIV patients, so I chose A)
B Antifungal
C Antihistaminic
D Antineoplastic(is this correct answer? since Kaposi sarcoma is also a tumor. But how to distinguish Kaposi with bacillary angiomatosis,I googled the pictures of these two disease nearly look the same)
E Antiparasitic

3.Give lovastatin, this treatment would result in which adaptive responses at cellular level?
A decreased hepatic expression of LDL-cholesterol receptors
B decreased transcription of HMG-CoA reductase(incorrect)
C increased mevalonic acid degradation
D increased mevalonic acid synthesis
E increased transcription of HMG-CoA reductase

4.A 68-year-old man with a 10-month history of shortness of breath and sweeling of his feet, family history of cardiovascular disease. He smoked 2 packs of cigarettes daily for 50 years. Puse 80/min, respirations 24/min, BP 150/80 mmHg. PE: 3+pitting edema of lower extremities. Diffuse, scattered wheezes are heard bilaterally on auscultation of the chest. Grade 2/6 pansystolic mumur heard best at lower left sternal border, which increases on inspiration. Maximal impulse palpated in sub-xiphoid area. S1 and S2 sounds are distant. Liver span 14cm. Diagnosis?
A Aortic stenosis
B Cardiac amyloidosis(incorrect)
C Cor pulmonale
D Coronary artery disease
E Primary pulmonary hypertension
Not have a clue, especially about the last 2 questions. Would anyone please give an explantion for me? Thanks a lot!

1. A 2. D 3. E 4. C