NBME 6 questions plz help

[sadaca]

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A previously healthy 51-year-old woman comes to the physician because of a 9kg (20lb) weight loss over the past 6 months. She has smoked 2 packs of cigarettes daily for 30 years. She takes no medications. Vital signs are within normal limits. Physical examination shows no abnormalities. Labs are as follows:

Hemoglobin: 17g/dL
Hematocrit: 52%
Leukocyte count: 5,100/mm3
Platelet count: 250,000/mm3
Serum urea nitrogen (BUN): 17mg/dL
Serum creatinine: 1.0mg/dL
Urine RBC: 14/hpf
Urine WBC: 1/hpf

Which of the following is the most likely diagnosis?

A) Endometrial carcinoma
B) Lung carcinoma
C) Polycythemia vera (wrong)
D) Renal carcinoma
E) Renal vein thrombosis

I was between B C and D . can someone please explain the right correct and how to exclude with this one?

 

[nguyen1025]

D) renal cell carcinoma

Smoking is a RF for renal carcinoma and the RBC in urine tips it off.

 

[sadaca]

hey thanks, did u get this right on your nbme 6? just wondering b/c some blogs said LUNG CANCER. How do u rule out LUNG CA and polycythemia plz? Appreciate it

 

[sadaca]

also RCC is more common in males im not sure . what do u all think

 

[Fatalis]

if they wanted lung cancer as the correct answer, they would give you serum levels of sodium/calcium or tell you that ACTH is elevated. Think about each answer choice and then ask yourself "what in the vignette would make this true"

 

[sadaca]

good point, thanks alot! I have some more if you get the chance plz take a look . Thanks in advance

I have found the answers from other blogs but no explaination on what the condition is with these cases . If you know plz share thank you.

A newborn who has not yet been fed is having respiratory distress. The abdomen is relatively flat, and there are no breath sounds over the thorax on the left. Frontal and lateral plain x-rays of the chest show a shift to the right of the mediastinal structures and opacification of the left hemithorax except for several sausage-shaped air collections posteriorly and inferiorly; the right lung is aerated normally. Which of the following abnormalities is most likely?
A ) Absence of the pericardium
B ) Posterolateral hernia of the left hemidiaphragm
C ) Pulmonary sequestration in the left lower lobe
D ) Retrosternal hernia
E ) Tracheoesophageal fistula




days after sustaining an acute myocardial infarction, a 65-year-old man develops and acute atrioventricular block. Despite resuscitative efforts and the placement of a pacemaker, the patient dies. An autopsy is requested. Ischemic injury to the atrioventricular node is the suspected cause of this patient’s atrioventricular block. Evaluation of a secretion from which of the following locations is the most appropriate to evaluate this patients atrioventricular node?

A) Interatrial septum near the attachment of the septal cusp of the tricuspid valve
B) Superior border of the muscular portion of the interventricular septum
C) Wall of the left atrium between the orifices of the right and left pulmonary veins
D) Wall of the right atrium along the orifice of the inferior vena cava
E) Wall of the right atrium along the orifice of the superior vena cava




A newborn who has not yet been fed is having respiratory distress. The abdomen is relatively flat, and there are no breath sounds over the thorax on the left. Frontal and lateral plain x-rays of the chest show a shift to the right of the mediastinal structures and opacification of the left hemithorax except for several sausage-shaped air collections posteriorly and inferiorly; the right lung is aerated normally. Which of the following abnormalities is most likely?
A ) Absence of the pericardium
B ) Posterolateral hernia of the left hemidiaphragm
C ) Pulmonary sequestration in the left lower lobe
D ) Retrosternal hernia
E ) Tracheoesophageal fistula

B ans?


wo days after sustaining an acute myocardial infarction, a 65-year-old man develops and acute atrioventricular block. Despite resuscitative efforts and the placement of a pacemaker, the patient dies. An autopsy is requested. Ischemic injury to the atrioventricular node is the suspected cause of this patient’s atrioventricular block. Evaluation of a secretion from which of the following locations is the most appropriate to evaluate this patient’s atrioventricular node?

A) Interatrial septum near the attachment of the septal cusp of the tricuspid valve
B) Superior border of the muscular portion of the interventricular septum
C) Wall of the left atrium between the orifices of the right and left pulmonary veins
D) Wall of the right atrium along the orifice of the inferior vena cava
E) Wall of the right atrium along the orifice of the superior vena cava

ans A ?
A newborn who has not yet been fed is having respiratory distress. The abdomen is relatively flat, and there are no breath sounds over the thorax on the left. Frontal and lateral plain x-rays of the chest show a shift to the right of the mediastinal structures and opacification of the left hemithorax except for several sausage-shaped air collections posteriorly and inferiorly; the right lung is aerated normally. Which of the following abnormalities is most likely?
A ) Absence of the pericardium
B ) Posterolateral hernia of the left hemidiaphragm
C ) Pulmonary sequestration in the left lower lobe
D ) Retrosternal hernia
E ) Tracheoesophageal fistula

B ans?


wo days after sustaining an acute myocardial infarction, a 65-year-old man develops and acute atrioventricular block. Despite resuscitative efforts and the placement of a pacemaker, the patient dies. An autopsy is requested. Ischemic injury to the atrioventricular node is the suspected cause of this patient’s atrioventricular block. Evaluation of a secretion from which of the following locations is the most appropriate to evaluate this patient’s atrioventricular node?

A) Interatrial septum near the attachment of the septal cusp of the tricuspid valve
B) Superior border of the muscular portion of the interventricular septum
C) Wall of the left atrium between the orifices of the right and left pulmonary veins
D) Wall of the right atrium along the orifice of the inferior vena cava
E) Wall of the right atrium along the orifice of the superior vena cava

ans A ?
A newborn who has not yet been fed is having respiratory distress. The abdomen is relatively flat, and there are no breath sounds over the thorax on the left. Frontal and lateral plain x-rays of the chest show a shift to the right of the mediastinal structures and opacification of the left hemithorax except for several sausage-shaped air collections posteriorly and inferiorly; the right lung is aerated normally. Which of the following abnormalities is most likely?
A ) Absence of the pericardium
B ) Posterolateral hernia of the left hemidiaphragm
C ) Pulmonary sequestration in the left lower lobe
D ) Retrosternal hernia
E ) Tracheoesophageal fistula

B ans?


wo days after sustaining an acute myocardial infarction, a 65-year-old man develops and acute atrioventricular block. Despite resuscitative efforts and the placement of a pacemaker, the patient dies. An autopsy is requested. Ischemic injury to the atrioventricular node is the suspected cause of this patient’s atrioventricular block. Evaluation of a secretion from which of the following locations is the most appropriate to evaluate this patient’s atrioventricular node?

A) Interatrial septum near the attachment of the septal cusp of the tricuspid valve
B) Superior border of the muscular portion of the interventricular septum
C) Wall of the left atrium between the orifices of the right and left pulmonary veins
D) Wall of the right atrium along the orifice of the inferior vena cava
E) Wall of the right atrium along the orifice of the superior vena cava

ans A ?

 

[sadaca]

sorry it copied too many times lol ! just the first two are the questions..thanks!

 

[Fatalis]

1- check out what a diaphragmatic hernia is; it will give you what you need to know
2- originally thought E [defect in the SA] but since your saying A is correct, gonna go with AV node defect

 

[sadaca]

thanks a lot Fatalis. I see about the diaphgramtic hernia . But the AV block, could u explain on what u think is going on there plz? Thanks!

I have another question if you want to take a stab at it :
An 18-year-old woman who has hepatocellular carcinoma is treated with a new chemotherapeutic agent. One week after initiation of therapy, examination of tissue obtained on biopsy of the liver shows that many neoplastic cells have decreased in size. Many fragments of membrane-bound structures containing condensed nuclear chromatin and organelles are identified. Electrophoresis on agarose gel of DNA isolated from this tissue shows a "ladder" consisting of multiple regularly spaced DNA bands. Activation of which of the following enzymes is most likely to be responsible for the alterations in DNA?

A ) DNA ligase

B ) DNA polymerase

C ) Endonuclease

D ) Phospholipase A2

E ) Transglutaminas
Ans on other blogs is C . This is xray /chemo radiation..I thought endonucleases repair UV radiation when it form thymdine dimers. How do u know to pick C here?

Appreciate your help

 

[Fatalis]

AV node is located at that location, vignette tells you he has a atriovent. block; seems appropriate.

 

[sadaca]

okay but AV node is ATRIOVENTRIUCLAR ..so why is the answer interATRIAL ? thanks

 

[sadaca]

does anyone know the biochem question posted above ?

 

[ABQ9988]

It's c. Endonuclease. They cleave phosphodiesterase bonds. Hence the findings.

 

[sadaca]

ok but how can u tell that the case is describing the cleavage of phosphodiesterase bonds? thanks alot

 

[notbobtrustme]

thanks a lot Fatalis. I see about the diaphgramtic hernia . But the AV block, could u explain on what u think is going on there plz? Thanks!

I have another question if you want to take a stab at it :
An 18-year-old woman who has hepatocellular carcinoma is treated with a new chemotherapeutic agent. One week after initiation of therapy, examination of tissue obtained on biopsy of the liver shows that many neoplastic cells have decreased in size. Many fragments of membrane-bound structures containing condensed nuclear chromatin and organelles are identified. Electrophoresis on agarose gel of DNA isolated from this tissue shows a "ladder" consisting of multiple regularly spaced DNA bands. Activation of which of the following enzymes is most likely to be responsible for the alterations in DNA?

A ) DNA ligase

B ) DNA polymerase

C ) Endonuclease

D ) Phospholipase A2

E ) Transglutaminas
Ans on other blogs is C . This is xray /chemo radiation..I thought endonucleases repair UV radiation when it form thymdine dimers. How do u know to pick C here?

Appreciate your help

This is talking about DNA laddering. Endonucleasases are part of the DNA repair pathway, but by themselves, they just cut DNA up, taking a nice clean band and turning it int a bunch of bands as evidenced by the picture (compared lane 2 to lanes 6 and 7). However, look at your other choices. DNA ligase makes small pieces larger by putting them back together. DNA polymerase makes DNA from primers + nucleotides. PLA2/TGase aren't involved with DNA synthesis/breakdown.

 

[Fatalis]

This is talking about DNA laddering. Endonucleasases are part of the DNA repair pathway, but by themselves, they just cut DNA up, taking a nice clean band and turning it int a bunch of bands as evidenced by the picture (compared lane 2 to lanes 6 and 7). However, look at your other choices. DNA ligase makes small pieces larger by putting them back together. DNA polymerase makes DNA from primers + nucleotides. PLA2/TGase aren't involved with DNA synthesis/breakdown.

that is so cool! thanks for sharing it!

 

[sadaca]

wow that makes it soo easy! god bless u love the pic explanation