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NBME 3 questions

Discussion in 'Step I' started by mrdowntoearth, Jul 23, 2006.

  1. mrdowntoearth

    mrdowntoearth Junior Member

    Jan 8, 2006
    Likes Received:
    Ok, here are a couple of questions from NBME 3. Let me know if my answers are wrong. Thanks

    1. 6 month-old male infant is sluggish and appears edematous. He has coarse immature facies and poor muscle tone. Which of the following is the most likely diagnosis?
    A. Achondroplasia
    B. Congenital hypothyroidism
    C. Diastrophic dwarfism
    D. Multiple cartilaginous exostoses
    E. Muscular dystrophy
    F. Myasthenia gravis
    G. Osteogenesis imperfecta
    H. Tay-Sachs disease ???
    I. Vit D deficiency rickets

    2. A 65 yo woman is brought to the ER because of lethargy and confusion for 24 hours. She did not fall or injure herself recently. Meds include amitriptyline (150 mg at bed time) for major depressive disorder and diphenhydramine for the past week (50 mg 3 times daily) for a pruritic rash. Her pulse is 100/min and regular and BP is 135/80. PE shows a palpable mass in the midline extending 5 cm upward from the pubic symphysis. Her BUN is 45 and creatinine is 2.8. Which of the following best explains the lab results?
    A. Acute tubular necrosis
    B. Bilat renal artery stenosis
    C. Bilat ureteral obstruction just distal to the renal pelvis
    D. Bilat ureteral obstruction proximal to the bladder
    E. Constrictive pericarditis
    F. Decreased ability to empty the bladder ???
    G. Interstitial nephritis

    3. 28 yo man comes to the physician b/c of 1 month hx of SOB with exertion. He has smoked 1 pack of cigaretters daily for 10 yrs. His father and his uncle died in their 40s of lung disease. The lungs are hyperresonant to percussion. Breath sounds are diffusely decreased. Pulse oximetry on room air while the patient is at rest shows a normal O2 sat thad decreases less than 86% when the pt climbs one flight of stairs. FEV is 1.0 L/min (25% of predicted) and FVC is 3.3 L/min (70% predicted). 5 years ago, his lung function was normal. Histologic examination of tissue obtained on biopsy is mostly to show which of the following?
    A. Bronchopulmonary dysplasia
    B. Chronic bronchitis
    C. Interstitial fibrosis
    D. Obliterative bronchiolitis
    E. Panacinar emphysema ?? b/c FEV1/FVC is below normal, so it's gotta be obstructive dz and he can't have chronic bronchitis since he doesn't have cough

    4. 35 yo man comes to the doctor b/c of 3 wk history of pain with urination and blood in his urine at the end of urination. He is a fishery consultant with the Peace Corps and returned to the USA 1 month ago following a 2 yr assignment in Africa. He frequently came in contact with lake water in Africa, ate locally prepared foods, and was sexually active with 2 women while using condoms consistently. PE shows no abnormalities. US of urinary tract shows bilat mild hydronephrosis and nodules in the bladder. Exposure to which of the following types of organisms is the most likely cause of this pt's condition?
    A. Bacteria
    B. Fungus
    C. Mycobacterium
    D. Parasite ??
    E. Virus

    5. 2 experimental drugs, drug X and Y, are being evaluated for the treatment of CHF. Pts receiving drug X have a cardiac index of 2.5L/m2 with a 95% confidence interval (CI) of 1.5 to 3.5. Pts receiving drug Y have a cardiac index of 1.7L/m2 with 95% CI of 0.7 to 2.7. A test of significance of difference shows a p-value of 0.1 Which of the following is the likelihood that the difference in mean cardiac index of pts receiving drug X and Y is due to chance?
    A. 0%
    B. 2.5%
    C. 5% ??? no idea just my guess
    D. 7.5%
    E. 10%
    F. 66.7%
    G. 95%

    6. 2 yo boy with normal size, weight, and development is brought to the doctor because of a painful, swollen left knee for the past week. He has had2 episodes of asymptomatic hematuria during the past 6 months. Both parents are healthy. He has achieved developmental milestones at appropriate ages. His height and weight are at the 70th percentile. Examination shows bruises and resolving hematomas on both elbows and signs of cutaneous hemorrhages at the site of a deep splinter. Lab studies show:
    Hgb: 12 g/dl
    Erythrocyte count: normal
    Leukocyte count: normal
    Bleeding time: normal
    PTT: increased

    The most likely diagnosis can be proven by the therapeutic response to a single injection of which of the following materials?
    A. Factor I (fibrinogen)
    B. Factor VIII (antihemophilic factor)
    C. Factor IX (plasma thromboplastin component) ??
    D. Folic acid
    E. Vit K
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  3. trudub

    trudub Senior Member

    Oct 23, 2003
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    #5 is 10%. The p value is the likelihood that the observed difference happened by chance. So, in this case, p = .1. #6 I am fairly sure is Factor VIII. This seems like a case of hemophilia and the most common form of hemophilia is hemophilia A which is deficient Factor VIII rather than hemophilia B which is deficient Factor IX.
  4. mrdowntoearth

    mrdowntoearth Junior Member

    Jan 8, 2006
    Likes Received:
    thanks for the explanations trudub! What about my other answers?

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