NBME 4 Spoiler

[acab]

45yo man with 2yr history of heavy smoking and daytime sleepiness. O2 sat goes to 87% when he sleeps. If left untreated, which of the following complications is most likely?

A. dilation of mitral annulus
B. microcytic hypochromic anemia
C. normocytic normochromic anemia
D. respiratory alkalosis
E. right ventricular hypertrophy
F. syndrome of inappropriate ADH release

I have no idea. I don't think he should have anemia because his hemoglobin content shouldn't be affected. Any thoughts?
My exam is tomorrow!

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[exmike]

45yo man with 2yr history of heavy smoking and daytime sleepiness. O2 sat goes to 87% when he sleeps. If left untreated, which of the following complications is most likely?

A. dilation of mitral annulus
B. microcytic hypochromic anemia
C. normocytic normochromic anemia
D. respiratory alkalosis
E. right ventricular hypertrophy
F. syndrome of inappropriate ADH release

I have no idea. I don't think he should have anemia because his hemoglobin content shouldn't be affected. Any thoughts?
My exam is tomorrow!

E from pulm HTN

 

[closertofine]

Disclaimer: this is probably totally in the wrong thread since I don't know which exam these came from, and I also don't know how to attach these images...but does anyone remember these two path questions and what the answers were/how to explain them?

19. A 68-year-old woman is admitted to the hospital for evaluation of gross hematuria. Two days after admission she develops aphasia and right hemiplegia, followed shortly by coma and death. The cut surface of one of her kidneys as seen at autopsy is shown. Which of the following was the most likely cause of the hematuria?

A) Metastatic cancer B) Papillary necrosis
C) Polycystic kidney disease D) Renal abscess
E) Renal cell carcinoma F) Renal infarct

(It looks to me like papillary necrosis...but I haven't seen enough pictures to be sure, and I'm not sure that makes sense).

1. A 9-year-old boy has had the lesions shown for several months. Which of the following histologic changes would be most likely if this lesion were biopsied?

A) Cytoid bodies and loss of adhesion to adjacent cells
B) Epidermal acanthosis with subepidermal blister
C) Epidermal thinning with marked inflammatory dermal infiltrate
D) Marked squamous cell dysplasia with thinned stratum corneum
E) Thickened stratum corneum and epidermis and vacuolated squamous cells


I know...that latter one especially is not very helpful without the picture. But anyone remember which test that came from so I can figure it out? Thanks.

 

[stochastic]

1. A 9-year-old boy has had the lesions shown for several months. Which of the following histologic changes would be most likely if this lesion were biopsied?

A) Cytoid bodies and loss of adhesion to adjacent cells
B) Epidermal acanthosis with subepidermal blister
C) Epidermal thinning with marked inflammatory dermal infiltrate
D) Marked squamous cell dysplasia with thinned stratum corneum
E) Thickened stratum corneum and epidermis and vacuolated squamous cells

The picture is of some warts. Therefore, the answer is E.

 

[stochastic]

19. A 68-year-old woman is admitted to the hospital for evaluation of gross hematuria. Two days after admission she develops aphasia and right hemiplegia, followed shortly by coma and death. The cut surface of one of her kidneys as seen at autopsy is shown. Which of the following was the most likely cause of the hematuria?

A) Metastatic cancer B) Papillary necrosis
C) Polycystic kidney disease D) Renal abscess
E) Renal cell carcinoma F) Renal infarct

F

After flipping all the way to the end, I come to find this one is on page 4. Well, I think I see a pale infart, which also (luckily) makes sense to me. If she is throwing of thrombi and infarcting her kidneys then she could very well have a stroke, which is what seems to have happened. The neurological events seem too acute for a neoplastic process and that is definitely not a kidney of APKD. I'm not really seeing the papillary necrosis, but path slides aren't my thing either. Anyone else hazard a guess?

 

[exmike]

Disclaimer: this is probably totally in the wrong thread since I don't know which exam these came from, and I also don't know how to attach these images...but does anyone remember these two path questions and what the answers were/how to explain them?

19. A 68-year-old woman is admitted to the hospital for evaluation of gross hematuria. Two days after admission she develops aphasia and right hemiplegia, followed shortly by coma and death. The cut surface of one of her kidneys as seen at autopsy is shown. Which of the following was the most likely cause of the hematuria?

A) Metastatic cancer B) Papillary necrosis
C) Polycystic kidney disease D) Renal abscess
E) Renal cell carcinoma F) Renal infarct

(It looks to me like papillary necrosis...but I haven't seen enough pictures to be sure, and I'm not sure that makes sense).


Thanks.

Probably F. sounds like she's thrombosing left and right.