Nbme 6

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combat

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A 35 year old woman comes to physician because of 2 week history of fever and headaches that see, to occur everyday. She recently returned from 1 month camping expedition in Cambodia. Her temp is 105.1F. Physical examination shows diaphoresis and splenomegaly. A peripheral blood smear shows Plasmodium vivax, and treatment with chloroquine is started and followed with course of primaquine. which of the following is best explanation for the inclusion of primaquine in this patient's medication regimen?

a) Cerebral Involvement.
b) Hemolysis.
c) High parasite load on the blood smear.
d) Minimal Toxicity.
e) Prevention of recurrence of malaria.

I chose E and i got it wrong, i thought primaquine is added to prevent further occurence, but it was wrong. Only option i can think from above is Hemolysis but not sure. Any one
 
I have a couple questions...

1) acts like the autoinhibitory effects of NE? B1 B2 A1 A2
is it refereeing to reflex bradycardia?

2) patient is anemic – low hematocrit/hemoglobin – increased Reticulocytes - microspherocytes – increased unconjugated bilirubin… what is the cause? Autoimmune hemolytic/HUS/TTP/Hypersplenism
I thought it was Spherocytosis so I put Hypersplenism. I'm thinking autoimmune hemolytic now but not sure why.

any help would be great...thanks!

not sure about 1...
but for 2, it was autoimmune. hypersplenism would consume platelets and lymphos too if i remember correctly. the autoimmunity part will actually make spherocytes. just taking a stab as to why... the IgG on the RBC makes some macros in the spleen take a chomp outta the IgG and a little bit of membrane on the RBC but not the whole thing.. less membrane leaves you with a spherocyte
 
1. A2 is the presynaptic inhibitory receptor, so it has an 'auto inhibitory' fx by (-)FB on the presynaptic neuron-->decreases SNS tone.

does anyone know if this test is easy/similar/harder than recently? i felt like the anatomy wasn't as bad as others have said. i'm going to take 7,11,12 soon and kind of want to know what i'm getting myself into.
 
not sure about 1...
but for 2, it was autoimmune. hypersplenism would consume platelets and lymphos too if i remember correctly. the autoimmunity part will actually make spherocytes. just taking a stab as to why... the IgG on the RBC makes some macros in the spleen take a chomp outta the IgG and a little bit of membrane on the RBC but not the whole thing.. less membrane leaves you with a spherocyte

I guess i'm confused on hypersplenism then. Pretty basic question but what causes hypersplenism? I know you get it from extrameduallary hematopoesis but I thought it happened also when the spleen had to work more at removing RBCs from circulation...so why wouldn't you get it in Autoimmune Hemolytic anemia as well?

thanks for the help.
 
76 year old man w/ hypothyoidism started on T4. what is the most likely effect of therapy after one month?
 
1) acts like the autoinhibitory effects of NE? B1 B2 A1 A2
is it refereeing to reflex bradycardia?

A2 - is on presynaptic and acts as regulator for ALL NTs released.

2) patient is anemic – low hematocrit/hemoglobin – increased Reticulocytes - microspherocytes – increased unconjugated bilirubin… what is the cause? Autoimmune hemolytic/HUS/TTP/Hypersplenism
I thought it was Spherocytosis so I put Hypersplenism. I'm thinking autoimmune hemolytic now but not sure why.

increased unconjugated bili --> intravascular hemolysis which would be autoimmune.
 
Hey guys...

So, I just took this & have some Qs:

-- specimen fr surgical wound; after overnight culture at 37C, which points to colony most likely to be a lab contaminant?

-- relationship betw repressor protein & expression of lac z gene in E coli; which mutation accounts for this relationship?

-- chromosomal abnormalities results in poor dev of cerebrl hemispheres, which structure in brainstem cross section most likely under-developed?

That's all for now.
 
-- specimen fr surgical wound; after overnight culture at 37C, which points to colony most likely to be a lab contaminant?

anything that grows off the streak lines, in this case it was ONE dot outside

-- relationship betw repressor protein & expression of lac z gene in E coli; which mutation accounts for this relationship?

need more than that... what was the question and described experiment.

-- chromosomal abnormalities results in poor dev of cerebrl hemispheres, which structure in brainstem cross section most likely under-developed?

well usually frontal lobes, think holoencephaly (ex: Patau's --> cyclop baby).... but I would need more info again.
 
Hey guys...

So, I just took this & have some Qs:

-- specimen fr surgical wound; after overnight culture at 37C, which points to colony most likely to be a lab contaminant?

-- relationship betw repressor protein & expression of lac z gene in E coli; which mutation accounts for this relationship?

-- chromosomal abnormalities results in poor dev of cerebrl hemispheres, which structure in brainstem cross section most likely under-developed?

That's all for now.

Its been a while since I took it so I might have the questions wrong but...

for specimen fr surgical wound; after overnight culture at 37C, which points to colony most likely to be a lab contaminant?
---> when you do cultures you scratch the sample on the plate. The answer is the one that isnt on a scratch mark and thus was not from the sample being tested.


chromosomal abnormalities results in poor dev of cerebrl hemispheres, which structure in brainstem cross section most likely under-developed?

---> was this the midbrain and did they have the cerebral peduncles in the cross section?
 
here's my question:
A 50 year old man has hearing loss due to cerumen impaction in his right ear. which of the following abnormalities are most likely on weber and rinne testing?

A) Weber lateralizes left, Rinne of right ear air>bone
B) Weber lateralizes left, Rinne bone>air
C) weber lateralizes to the right, Rinne air>bone
D) wber lateralizes to the right, rinne bone>air

im thinking D....
 
here's my question:
A 50 year old man has hearing loss due to cerumen impaction in his right ear. which of the following abnormalities are most likely on weber and rinne testing?

A) Weber lateralizes left, Rinne of right ear air>bone
B) Weber lateralizes left, Rinne bone>air
C) weber lateralizes to the right, Rinne air>bone
D) wber lateralizes to the right, rinne bone>air

im thinking D....

yea its D. if you plug your ear with you finger and hum you hear it more on the ipsalateral ear. Air > bone only if nerve defect (or normal)
 
Hey guys...

-- relationship betw repressor protein & expression of lac z gene in E coli; which mutation accounts for this relationship?

The answer to this one was defect in the repressor binding to operator site. Normally lac operon is repressed when repressor protein binds to operator. When lactose is present, it binds to repressor making it unable to bind to operator site. Therefore increasing lacZ product (b-galactosidase).


-- chromosomal abnormalities results in poor dev of cerebrl hemispheres, which structure in brainstem cross section most likely under-developed?

it was the pyramids (corticospinal tract).

That's all for now.

On a side note I just had a question about the scoring. Has anyone taken it recently? Did they update the scale? i got 170/200 (85%) and it only put me at a 530/228. I took nbme 11 5 days ago and got 171/200 and got a 560/235 (both tests were from nbme website)
 
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On a side note I just had a question about the scoring. Has anyone taken it recently? Did they update the scale? i got 170/200 (85%) and it only put me at a 530/228. I took nbme 11 5 days ago and got 171/200 and got a 560/235 (both tests were from nbme website)

i know nbme 6 and 7 were re-scaled within the last 2 months so that it was harder. I think your scores are representative of the current scales for both nbme 11 and 6.
 
alright thanks, I heard they rescaled it a few months ago but was curious if they did it again.
 
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Does anyone know the answer to that question with the histological slide and says a golfer has a red scaly nodule on the helix of his left ear and then asks for the precursor lesion. I assumed it was a melanoma because i saw some dark spots on the slide so i picked dysplastic nevus but that turned out to be incorrect.
Also one more question, the one regarding mannitol and a chart, does a patient's serum's osmolarity increase or decrease after mannitol because I read some places it increases and then I read it also decreases osmolarity, and what about the ADH level. would that increase or decrease ? Thanks
 
Does anyone know the answer to that question with the histological slide and says a golfer has a red scaly nodule on the helix of his left ear and then asks for the precursor lesion. I assumed it was a melanoma because i saw some dark spots on the slide so i picked dysplastic nevus but that turned out to be incorrect.
Also one more question, the one regarding mannitol and a chart, does a patient's serum's osmolarity increase or decrease after mannitol because I read some places it increases and then I read it also decreases osmolarity, and what about the ADH level. would that increase or decrease ? Thanks

the histo slide had a keratin nodule = SCCA
answer was actinic keratosis (precursor lesion to scca)

if i remember correctly the answer was A, increase osmolarity (diuresis) and increase in ADH release (response to inc osmolarity)
 
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25. A 24-year-old woman who is a farm worker has had progressive dyspnea and intermittent fevers over the past 6 months. An x-ray of the chest shows diffuse interstitial nodular densities. Examination of tissue obtained on lung biopsy shows accumulation of chronic inflammatory cells in the interstitium and noncaseating, loosely formed granulomas. Which of the following is the most likely diagnosis? A
) Acute respiratory distress syndrome B
) Asbestosis C
) Hypersensitivity pneumonitis D
) Pneumocystis pneumonia E
) Silicosis


28. An 8-year-old boy has had generalized edema for 2 months. Laboratory studies of serum show:
Glucose
89 mg/dL
Creatinine
0.9 mg/dL
Urea nitrogen (BUN)
11 mg/dL
Albumin
2.8 g/dL

Urinalysis shows 4+ protein and oval fat bodies. The most likely cause is a disorder involving which of the following structures?

A
) Afferent arterioles only B
) Afferent and efferent arterioles C
) Glomerular capillary loops D
) Glomerular mesangial region E
) Tubulo-interstitial region

itdmedia.aspx


39.
A 62-year-old woman comes to the physician because of a 4-week history of progressive shortness of breath. Her temperature is 37.8°C (100°F), pulse is 96/min, respirations are 28/min, and blood pressure is 162/86 mm Hg. Her jugular venous pressure is 20 cm H2O, carotid upstrokes are decreased, and the trachea is midline. There is dullness to percussion at the base of both lung fields, breath sounds are decreased at both bases, and there are crackles halfway up both lung fields. Cardiac examination shows a normal S1 and S2, an S3 gallop, and a grade 2/6 holosystolic murmur heard at the apex. Which of the following is the most likely diagnosis? A
) Atelectasis B
) Bronchospasm C
) Congestive heart failure D
) Consolidation E
) Pulmonary hypertension





itdmedia.aspx


http://www.starttest.com/api/5.1.1....&previouspage=SCAW1750MBF2953#SCAB0121MAI8473n
43. Cells of the adrenal medulla secrete catecholamines when the sympathetic nervous system is powerfully stimulated. Which of the following neurotransmitters is used to activate the chromaffin cells? A
) Acetylcholine B
) Epinephrine C
) Glutamate D
) Histamine E
) Norepinephrine



44. A 2-year-old boy has higher blood pressure in the right arm than in the left arm, decreased femoral pulses, and a systolic ejection murmur heard best below the left clavicle. Which of the following is the most likely cause of this congenital anomaly? A
) Abnormal development of the aorta B
) Dextrocardia with situs inversus C
) Incomplete partitioning of the atrioventricular canal D
) Persistent fetal circulation E
) Transposition of the great vessels



45. A 35-year-old woman with primary pulmonary hypertension undergoes an uncomplicated right lung transplantation. One month later, her FEV1 is normal, and an exercise stress test shows no abnormalities. Which of the following is most likely to be increased in the transplanted lung compared with the left lung? A
) Airway resistance B
) Blood flow C
) Cough reflex D
) Lung compliance E
) Mucociliary clearance F
) Vascular resistance


itdmedia.aspx


A 60-year-old woman is undergoing surgical excision of a renal cell carcinoma thrombus that extends into the right renal vein. During the procedure, the vena cava is temporarily occluded above the renal veins. Increased venous pressure is most likely to be noted in which of the following veins during the period of occlusion? A
) External iliac B
) Hepatic C
) Inferior mesenteric D
) Portal E
) Splenic .




37. A newborn who is born at 27 weeks' gestation has respiratory distress syndrome. This most likely results from inadequate secretion from which of the following cell types labeled in the illustration of the alveolar wall shown?
itdmedia.aspx

A
) B
) C
) D
) E
)
 
2. Many human genes encode more than one polypeptide sequence. Which of the following mechanisms accounts for the production of more than one protein by one human gene in most cases? A
) Alternative splicing of the transcript B
) Production of a polycistronic mRNA C
) Reading mRNA in both directions D
) Reading mRNA in more than one reading frame E
) Transcription of both strands of the gene Your answer is indicated by the filled-in circle.



itdmedia.aspx

8. Two children in a family have a disease characterized by mental ******ation and mild dysmorphic features. The family was evaluated by standard karyotype and then by DNA microsatellite polymorphism studies for two autosomal markers. A pedigree is shown. Which of the following is the most likely cause of the congenital disorder? A
) Anticipation B
) Autosomal recessive inheritance C
) Genomic imprinting D
) Mitochondrial inheritance

itdmedia.aspx


13. An HIV virus has been isolated that is not inhibited by soluble CD4. Mutations are most likely to have occurred in the viral gene encoding which of the following? A
) Core B
) Glycoprotein C
) Integrase D
) Matrix E
) Reverse transcriptase Your answer is indicated by the filled-in circle.



45. A 35-year-old woman with primary pulmonary hypertension undergoes an uncomplicated right lung transplantation. One month later, her FEV1 is normal, and an exercise stress test shows no abnormalities. Which of the following is most likely to be increased in the transplanted lung compared with the left lung? A
) Airway resistance B
) Blood flow C
) Cough reflex D
) Lung compliance E
) Mucociliary clearance F
) Vascular resistance Your answer is indicated by the filled-in circle.



itdmedia.aspx

49. 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 Your answer is indicated by the filled-in circle.



itdmedia.aspx



An investigator is evaluating the outcome of coronary artery bypass grafting conducted by two surgeons in the community in the past year. Surgeon X, who operates exclusively at a tertiary-care facility, has a 30-day operative mortality of 3%. Surgeon Y, who operates exclusively at a community care facility, has a 30-day operative mortality of 1%. The difference in operative mortality between surgeon X and surgeon Y is significant (p<0.05). The investigator concludes that patients should have care at the community care facility. Which of the following raises the most concern regarding the validity of this conclusion? A
) Lack of control of case complexity B
) Lack of control of patient cholesterol data C
) Lack of control of patient follow-up D
) Lack of control of patient recuperation E
) Unequal sample sizes between surgeons Your answer is indicated by the filled-in circle.



itdmedia.aspx


A 22-year-old woman participates in a clinical study of a putative protein hormone that is synthesized in the liver in response to a decrease in the blood platelet concentration. Injection of the hormone causes an increase in platelet production. Which of the following is the most likely location of the receptor that accounts for the increase in platelet count? A
) In the cytoplasm of hepatocytes B
) In the cytoplasm of megakaryocytes C
) In the nucleus of hepatocytes D
) In the nucleus of megakaryocytes E
) On the cell membrane of hepatocytes F
) On the cell membrane of megakaryocytes Your answer is indicated by the filled-in circle.



itdmedia.aspx
itdmedia.aspx

Solution
44. Treatment of respiratory syncytial virus with 70% ethanol destroys its infectivity. The loss of infectivity is the result of a direct effect of the treatment on which of the following viral functions? A
) Entry of the nucleocapsid into the nucleus B
) Fusion of the virion membrane with the target cell membrane C
) Replication of the virus genome D
) Transcription of mRNA Your answer is indicated by the filled-in circle.


itdmedia.aspx
n
19. A 20-year-old woman comes to the physician for an examination prior to participating on the college varsity volleyball team. She has a 1-month history of mild facial acne. Physical examination shows no other abnormalities. Treatment with a topical agent is begun. Three weeks later, she returns to the physician because of leg swelling and weight gain. Physical examination shows severe facial acne and acne on the chest and back. There is 2+ pitting edema of the lower extremities. Laboratory studies show a mildly increased serum direct bilirubin concentration and serum transaminase activities. The most likely cause of her condition is self-administration of which of the following substances? A
) ACTH B
) Ethinyl estradiol C
) Growth hormone D
) Hydrocortisone E
) Methandrostenolone Your answer is indicated by the filled-in circle.



itdmedia.aspx

49. A 48-year-old man comes to the physician with his wife because of a 10-month history of headache and daytime sleepiness. His wife says that he snores at night and often stops breathing while sleeping. He has no history of any major medical illness and takes no medications. He is 173 cm (5 ft 8 in) tall and weighs 115 kg (253 lb); BMI is 39 kg/m2. His blood pressure is 150/110 mm Hg. Physical examination shows no other abnormalities. Overnight polysomnography confirms the diagnosis. Nocturnal treatment with nasal bi-level positive airway pressure is most appropriate for this patient to accomplish which of the following? A
) Allowing the airway to remain patent for appropriate ventilation B
) Decreasing the work of breathing during the respiratory cycle C
) Reducing airway secretions during the ventilatory cycle D
) Stimulating increased lung compliance on inspiration and decreased lung compliance on expiration E
) Stimulating increased respirations by splinting the mouth and nose Your answer is indicated by the filled-in circle.











Your answer is indicated by the filled-in circle.
 
what exactly do you need help, on the ones you got wrong? i cant tell which ones those are
 
Yes, I got those wrong. If anyone could please either tell me the answer or explain, it would be very much appreciated. Thanks.
 
25. A 24-year-old woman who is a farm worker has had progressive dyspnea and intermittent fevers over the past 6 months. An x-ray of the chest shows diffuse interstitial nodular densities. Examination of tissue obtained on lung biopsy shows accumulation of chronic inflammatory cells in the interstitium and noncaseating, loosely formed granulomas. Which of the following is the most likely diagnosis? A
) Acute respiratory distress syndrome B
) Asbestosis C
) Hypersensitivity pneumonitis D
) Pneumocystis pneumonia E
) Silicosis


28. An 8-year-old boy has had generalized edema for 2 months. Laboratory studies of serum show:
Glucose
89 mg/dL
Creatinine
0.9 mg/dL
Urea nitrogen (BUN)
11 mg/dL
Albumin
2.8 g/dL

Urinalysis shows 4+ protein and oval fat bodies. The most likely cause is a disorder involving which of the following structures?

A
) Afferent arterioles only B
) Afferent and efferent arterioles C
) Glomerular capillary loops D minimal change
) Glomerular mesangial region E
) Tubulo-interstitial region

itdmedia.aspx


39.
A 62-year-old woman comes to the physician because of a 4-week history of progressive shortness of breath. Her temperature is 37.8°C (100°F), pulse is 96/min, respirations are 28/min, and blood pressure is 162/86 mm Hg. Her jugular venous pressure is 20 cm H2O, carotid upstrokes are decreased, and the trachea is midline. There is dullness to percussion at the base of both lung fields, breath sounds are decreased at both bases, and there are crackles halfway up both lung fields. Cardiac examination shows a normal S1 and S2, an S3 gallop, and a grade 2/6 holosystolic murmur heard at the apex. Which of the following is the most likely diagnosis? A
) Atelectasis B
) Bronchospasm C
) Congestive heart failure D
) Consolidation E
) Pulmonary hypertension





itdmedia.aspx


http://www.starttest.com/api/5.1.1....&previouspage=SCAW1750MBF2953#SCAB0121MAI8473n
43. Cells of the adrenal medulla secrete catecholamines when the sympathetic nervous system is powerfully stimulated. Which of the following neurotransmitters is used to activate the chromaffin cells? A
) Acetylcholine B
) Epinephrine C
) Glutamate D
) Histamine E
) Norepinephrine



44. A 2-year-old boy has higher blood pressure in the right arm than in the left arm, decreased femoral pulses, and a systolic ejection murmur heard best below the left clavicle. Which of the following is the most likely cause of this congenital anomaly? A
) Abnormal development of the aorta B coarctation
) Dextrocardia with situs inversus C
) Incomplete partitioning of the atrioventricular canal D
) Persistent fetal circulation E
) Transposition of the great vessels



45. A 35-year-old woman with primary pulmonary hypertension undergoes an uncomplicated right lung transplantation. One month later, her FEV1 is normal, and an exercise stress test shows no abnormalities. Which of the following is most likely to be increased in the transplanted lung compared with the left lung? A
) Airway resistance B
) Blood flow C
) Cough reflex D
) Lung compliance E
) Mucociliary clearance F
) Vascular resistance

itdmedia.aspx


A 60-year-old woman is undergoing surgical excision of a renal cell carcinoma thrombus that extends into the right renal vein. During the procedure, the vena cava is temporarily occluded above the renal veins. Increased venous pressure is most likely to be noted in which of the following veins during the period of occlusion? A
) External iliac B im pretty sure on this one, i know it isnt inf mes
) Hepatic C
) Inferior mesenteric D
) Portal E
) Splenic .




37. A newborn who is born at 27 weeks' gestation has respiratory distress syndrome. This most likely results from inadequate secretion from which of the following cell types labeled in the illustration of the alveolar wall shown?
itdmedia.aspx

A
) B
) C
) D type II pneumocyte
) E
)

the explanations are pretty much all in FA
 
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I put increased vascular resistance and got it wrong. Also, in the picture, I knew it was a type 2 pneumocyte but I could not tell which one that was in the picture. The picture in FA was not helpful. Thanks for your help.
 
In #45 why is the vascular resistance up in the transplanted lung?

I would have thought the answer to #45 would be blood flow. I assume that the non-transplant lung still has the vasoconstriction that lead to the Pulm hypertension and now that a "normal" transplant lung is there it would get more blood flow due to lower resistance.
 
In #45 why is the vascular resistance up in the transplanted lung?

The answer is blood flow not vascular resistance.

I would have thought the answer to #45 would be blood flow. I assume that the non-transplant lung still has the vasoconstriction that lead to the Pulm hypertension and now that a "normal" transplant lung is there it would get more blood flow due to lower resistance.

You are correct sir!
 
I would have thought the answer to #45 would be blood flow. I assume that the non-transplant lung still has the vasoconstriction that lead to the Pulm hypertension and now that a "normal" transplant lung is there it would get more blood flow due to lower resistance.


my apologies you guys are correct, i went over it kind of fast i remember it had to do somethign with resistance/blood flow. thanks for catching it, i edited.
 
2. Many human genes encode more than one polypeptide sequence. Which of the following mechanisms accounts for the production of more than one protein by one human gene in most cases? A
) Alternative splicing of the transcript B i got this wrong, was between a and b for me
) Production of a polycistronic mRNA C
) Reading mRNA in both directions D
) Reading mRNA in more than one reading frame E
) Transcription of both strands of the gene Your answer is indicated by the filled-in circle.



itdmedia.aspx

8. Two children in a family have a disease characterized by mental ******ation and mild dysmorphic features. The family was evaluated by standard karyotype and then by DNA microsatellite polymorphism studies for two autosomal markers. A pedigree is shown. Which of the following is the most likely cause of the congenital disorder? A
) Anticipation B
) Autosomal recessive inheritance C
) Genomic imprinting D
) Mitochondrial inheritance

itdmedia.aspx


13. An HIV virus has been isolated that is not inhibited by soluble CD4. Mutations are most likely to have occurred in the viral gene encoding which of the following? A
) Core B
) Glycoprotein C
) Integrase D
) Matrix E
) Reverse transcriptase Your answer is indicated by the filled-in circle.



45. A 35-year-old woman with primary pulmonary hypertension undergoes an uncomplicated right lung transplantation. One month later, her FEV1 is normal, and an exercise stress test shows no abnormalities. Which of the following is most likely to be increased in the transplanted lung compared with the left lung? A
) Airway resistance B
) Blood flow C
) Cough reflex D
) Lung compliance E
) Mucociliary clearance F
) Vascular resistance Your answer is indicated by the filled-in circle.



itdmedia.aspx

49. 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 Your answer is indicated by the filled-in circle.



itdmedia.aspx



An investigator is evaluating the outcome of coronary artery bypass grafting conducted by two surgeons in the community in the past year. Surgeon X, who operates exclusively at a tertiary-care facility, has a 30-day operative mortality of 3%. Surgeon Y, who operates exclusively at a community care facility, has a 30-day operative mortality of 1%. The difference in operative mortality between surgeon X and surgeon Y is significant (p<0.05). The investigator concludes that patients should have care at the community care facility. Which of the following raises the most concern regarding the validity of this conclusion? A
) Lack of control of case complexity B
) Lack of control of patient cholesterol data C
) Lack of control of patient follow-up D
) Lack of control of patient recuperation E
) Unequal sample sizes between surgeons Your answer is indicated by the filled-in circle.



itdmedia.aspx


A 22-year-old woman participates in a clinical study of a putative protein hormone that is synthesized in the liver in response to a decrease in the blood platelet concentration. Injection of the hormone causes an increase in platelet production. Which of the following is the most likely location of the receptor that accounts for the increase in platelet count? A
) In the cytoplasm of hepatocytes B
) In the cytoplasm of megakaryocytes C
) In the nucleus of hepatocytes D
) In the nucleus of megakaryocytes E
) On the cell membrane of hepatocytes F
) On the cell membrane of megakaryocytes Your answer is indicated by the filled-in circle.



itdmedia.aspx
itdmedia.aspx

Solution
44. Treatment of respiratory syncytial virus with 70% ethanol destroys its infectivity. The loss of infectivity is the result of a direct effect of the treatment on which of the following viral functions? A
) Entry of the nucleocapsid into the nucleus B
) Fusion of the virion membrane with the target cell membrane C i think it was this one
) Replication of the virus genome D
) Transcription of mRNA Your answer is indicated by the filled-in circle.


itdmedia.aspx
n
19. A 20-year-old woman comes to the physician for an examination prior to participating on the college varsity volleyball team. She has a 1-month history of mild facial acne. Physical examination shows no other abnormalities. Treatment with a topical agent is begun. Three weeks later, she returns to the physician because of leg swelling and weight gain. Physical examination shows severe facial acne and acne on the chest and back. There is 2+ pitting edema of the lower extremities. Laboratory studies show a mildly increased serum direct bilirubin concentration and serum transaminase activities. The most likely cause of her condition is self-administration of which of the following substances? A
) ACTH B
) Ethinyl estradiol C
) Growth hormone D
) Hydrocortisone E
) Methandrostenolone Your answer is indicated by the filled-in circle.



itdmedia.aspx

49. A 48-year-old man comes to the physician with his wife because of a 10-month history of headache and daytime sleepiness. His wife says that he snores at night and often stops breathing while sleeping. He has no history of any major medical illness and takes no medications. He is 173 cm (5 ft 8 in) tall and weighs 115 kg (253 lb); BMI is 39 kg/m2. His blood pressure is 150/110 mm Hg. Physical examination shows no other abnormalities. Overnight polysomnography confirms the diagnosis. Nocturnal treatment with nasal bi-level positive airway pressure is most appropriate for this patient to accomplish which of the following? A
) Allowing the airway to remain patent for appropriate ventilation B
) Decreasing the work of breathing during the respiratory cycle C
) Reducing airway secretions during the ventilatory cycle D
) Stimulating increased lung compliance on inspiration and decreased lung compliance on expiration E
) Stimulating increased respirations by splinting the mouth and nose Your answer is indicated by the filled-in circle.











Your answer is indicated by the filled-in circle.

please let me know if you guys disagree i went over them kind of fast again.
 
OK thanks! I remember in the kaplan videos the guy said that the herniation is always in the posterolateral direction due to the strength of the posterior longitudinal ligament.

This patient has footdrop, so this herniation is involving the anterior ramus of the spinal nerve? So I chose the anterior longitudinal ligament?

If the herniation is into the spinal cord root nerves, then this is not in an anterior direction, hence cannot interact with the anterior longitudinal ligament. Best choice is then posterior ligament.
 
Okay here goes:
1. Isotonic saline 2L, how much goes into the extracellular fluid, I thought it was be 1/3 x 2 but 2/3 wasn't a choice ...
2. 31 yo W with retrosternal chest pain in the last two months. ST segment elevation. what epicardial artery event causes this?
3. 35 yo M with epigastric pain not responding to meds, mass in head of pancreas ... acinar carcinoma? I put ductal adenocarcinoma.
4. A left kidney 69 yo M .. gave gross pic, what is the tissue alterations
5. sexually active 18 yo W with rash including palms/soles. weeping plaques on gentilas, dense chronic inflam rich in plasma cells, swelling of endothelial cells occluding small vessels? What organism?
6. newborn with respiratory distress. I thought it was bowels herniating above diaphram.
7. 45 yo W with scleroderma, what inflamm cell releases cytokines that causes the dermological changes?
8. 28 yo W pelvic neoplasm mature glandular and chondroid elements and cyts lined by stratified squamous epithelium, dx?
9. Autistic boy. Parents want 12 yo daughter test to determine carrier state?
10. Infant RDS and it said inadequate secretion. I can even identify pneumocyte type II ...
11. 3 day old new born with meningitis. neutrophils and gram -ve rods? E. coli or H. influenza B
12. Disc herniation pushes on what ligament that compresses on spinal roots
13. 82 yo man unconscious hit by car, gives CY, where is the bleed
14. what noradrenergic receptor is found on both pre/post synaptic
15. The probably of surviving 4+ years after being alive for 2 years
16. 24 yo W shifting towards bone net loss?
17. A 22 yo W marathon runner stress fracture. What is going to have decrease bone density. it isn't PTH excess
18. 17 yo W with headaches and episodes of fading vision?
19. fish oil vs olive oil
20. 13 yo smoker. what would you tell him
21. graph with NE plus drug X
22. bad development of cerebral hemispheres with structure in brain stem is atrophied?
23. 28 yo mother with 3 children, which healthcare plan to use
24. levodopa vs levodopa + drug x
25. 66 yo M with difficult urinating. metoprolol, thiazide, insulin, mg(oh)2, dipherhydramine ... which drug causes that
26. lung transplant ... what is the contraindication
27. neural precursors migrate into which gut organ


can you someone explain 15?
 
can you someone explain 15?


the patient survived interval 1-2 so you only take into account the probabilities after that time frame until year 4 (interval 3-4). surviving interval 2-3 is 84% and surviving interval 3-4 and thus making it to the beginning of year 4 is 85%. So you multiply these two probabilities
 
A 55 yo man has burning pain when he walks rapidly. Improves upon rest. Smoked 2 pack cig a day for 40 years. SKin over his lower extrems is shiny, scaly has normal color and temp. Femoral pulses are weak. Hb 14. Which describes mycocyte cellular changes during painful episodes?

A- Cytoplasmic swelling
B- Increase densities of mitochondria
C- Karyohexxis
D- Lysis of Er
E- Rupture of endosomes.



THe question about a 60 something lady went grocey shopping and came to the Er with extreme pain in the lower middle back......that was compression fracture of L4 right?


A 20 y.ol woman with difficulty breathing for 2 hrs. Overdistended chest marked restriction of expansion. Increased blood eosinophils and eosinophils in sputum. Which is most likely sequence of events for initial sensitization of to allergen causing these findings?

A- cytokine-----IgE-------T-Lymph induction
B- IgE------B lymp------T lymph
C- IgE------T lymph------cytokine
D- T-------cytokine-------IgE
 
also what are everyone doing to improve on "general principles"????

that category to me is a "know everything out there" category. I have no idea how I can improve on that! One question that was in the NBME was a health insurance question for some newly employed lady.
 
also what are everyone doing to improve on "general principles"????

that category to me is a "know everything out there" category. I have no idea how I can improve on that! One question that was in the NBME was a health insurance question for some newly employed lady.

I also scored low in that category. Any thoughts on how to get this score up?
 
A 35 year old woman comes to physician because of 2 week history of fever and headaches that see, to occur everyday. She recently returned from 1 month camping expedition in Cambodia. Her temp is 105.1F. Physical examination shows diaphoresis and splenomegaly. A peripheral blood smear shows Plasmodium vivax, and treatment with chloroquine is started and followed with course of primaquine. which of the following is best explanation for the inclusion of primaquine in this patient's medication regimen?

a) Cerebral Involvement.
b) Hemolysis.
c) High parasite load on the blood smear.
d) Minimal Toxicity.
e) Prevention of recurrence of malaria.

I chose E and i got it wrong, i thought primaquine is added to prevent further occurence, but it was wrong. Only option i can think from above is Hemolysis but not sure. Any one

E!!! Limit the bad guys in the liver
 
THere was a question in this NBME asking about how CO2 is carried.

I picked in RBCs....isnt that right? I got that wrong?

I thought CO2 was carried a HCO3 in RBC.
 
q1
A 55-year-old man has a 2-week history of intense burning pain in his calves when he walks rapidly. The pain is relieved by resting. He has smoked 2 packs of cigarettes daily for 40 years. The skin on his lower extremities is dry, scaly, and shiny with normal color and temperature. Femoral pulses are weak. Hemoglobin concentration is 14 g/dL. Which of the following best describes the cellular changes in the myocytes in his calves during the painful episodes?
A ) Cytoplasmic swelling
B ) Formation of large densities in mitochondria
C ) Karyorrhexis
D ) Lysis of endoplasmic reticulum
E ) Rupture of lysosomes
q2
A healthy 26-year-old woman comes to the physician for a health maintenance examination. She says that her moods change easily and that she has seen numerous psychiatrists and therapists for "emotional problems." Physical examination shows multiple healing, self-inflicted wounds. At the end of the examination, she thanks the physician for "being the most skilled, compassionate, and understanding physician I have ever known." Which of the following is the most likely diagnosis?
A ) Bipolar disorder
B ) Borderline personality disorder
C ) Dysthymic disorder
D ) Histrionic personality disorder
E ) Major depressive disorder
q3

Embryonic chondrogenesis requires the formation of mesenchymal condensations at the sites of future cartilage. During this developmental step, cAMP concentrations in the cells comprising the condensation increase significantly. Treatment with a membrane-permeable form of cAMP (eg, dibutyryl cAMP) allows individual mesenchymal cells to differentiate into chondrocytes without first forming these condensations. Inhibition of which of the following enzymes would most directly inhibit dibutyryl cAMP-mediated induction of chondrogenesis from mesenchyme?
A ) Guanylyl cyclase
B ) Phosphodiesterase
C ) Proteasome
D ) Protein kinase A
E ) Tyrosine kinase

q4

A 2-year-old girl is admitted to the hospital for the second time since birth because of pneumonia and respiratory distress for 1 week. She appears poorly developed and thin. Her respirations are 42/min. Physical examination shows mild respiratory distress. An x-ray of the chest shows hyperinflation with infiltrates in the right middle and right lower lobes of the lung. During hospitalization, the patient has greasy bowel movements with a pungent odor. A sweat chloride test confirms the diagnosis, and the patient is started on a special formula with oral supplementation of fat-soluble vitamins. If the incidence of this genetic disease is 1/2500 among whites, which of the following is the approximate carrier frequency of this mendelian trait in this population?
A ) 1/12
B ) 1/25
C ) 1/50
D ) 1/125
E ) 1/625

q5
3. A 4-year-old boy is brought to the physician by his parents because of global developmental delays and odd behaviors such as hand flapping. His mother has a learning disability, and his maternal uncle has mental ******ation. Physical examination shows macrocephaly, large ears, and a prominent chin. He has a 3-word vocabulary. A diagnosis of fragile X syndrome is made. After the parents are informed of the results, they ask if their healthy 12-year-old daughter, who has met all developmental milestones, should be tested to determine her carrier status. Which of the following responses by the physician is most appropriate?
A ) "I recommend testing her now so that she can be prepared for what may lie ahead if she has children."
B ) "I recommend waiting until she is older and mature enough to decide for herself if she would like to be tested."
C ) "It would be better if she were at least 16 years of age, closer to her childbearing years, before testing was initiated."
D ) "Let's discuss the situation with her, review the pros and cons of testing, and then ask her if she would like to be tested now."
E ) "Let's hold off on that and discuss the options with her when she is planning to marry and have children."

q6
A 45-year-old woman comes to the physician because of a 6-month history of mouth ulcers, thickening of the skin, and throbbing pain in her hands when they are exposed to the cold. She also has had a 1-month history of severe headaches and difficulty swallowing. Physical examination shows small red lesions around the mouth and generalized muscle weakness. Laboratory studies show a high titer of anti-Scl 70 (anti-topoisomerase I) antibody. A biopsy specimen of the skin shows thinning of the epidermis, hyalinization and obliteration of arterioles, and dermal thickening. These dermatologic changes are caused primarily by the release of chemokines from which of the following inflammatory cell types?
A ) Endothelial cells
B ) Eosinophils
C ) Lymphocytes
D ) Mast cells
E ) Platelets
F ) Segmented neutrophils
 
q1
A 55-year-old man has a 2-week history of intense burning pain in his calves when he walks rapidly. The pain is relieved by resting. He has smoked 2 packs of cigarettes daily for 40 years. The skin on his lower extremities is dry, scaly, and shiny with normal color and temperature. Femoral pulses are weak. Hemoglobin concentration is 14 g/dL. Which of the following best describes the cellular changes in the myocytes in his calves during the painful episodes?
A ) Cytoplasmic swelling -only reversible option here
B ) Formation of large densities in mitochondria
C ) Karyorrhexis
D ) Lysis of endoplasmic reticulum
E ) Rupture of lysosomes
q2
A healthy 26-year-old woman comes to the physician for a health maintenance examination. She says that her moods change easily and that she has seen numerous psychiatrists and therapists for "emotional problems." Physical examination shows multiple healing, self-inflicted wounds. At the end of the examination, she thanks the physician for "being the most skilled, compassionate, and understanding physician I have ever known." Which of the following is the most likely diagnosis?
A ) Bipolar disorder
B ) Borderline personality disorder - she is displaying two extremes
C ) Dysthymic disorder
D ) Histrionic personality disorder
E ) Major depressive disorder
q3

Embryonic chondrogenesis requires the formation of mesenchymal condensations at the sites of future cartilage. During this developmental step, cAMP concentrations in the cells comprising the condensation increase significantly. Treatment with a membrane-permeable form of cAMP (eg, dibutyryl cAMP) allows individual mesenchymal cells to differentiate into chondrocytes without first forming these condensations. Inhibition of which of the following enzymes would most directly inhibit dibutyryl cAMP-mediated induction of chondrogenesis from mesenchyme?
A ) Guanylyl cyclase
B ) Phosphodiesterase
C ) Proteasome
D ) Protein kinase A - increased by cAMP, so it will inhibited by inhibiting cAMP

E ) Tyrosine kinase

q4

A 2-year-old girl is admitted to the hospital for the second time since birth because of pneumonia and respiratory distress for 1 week. She appears poorly developed and thin. Her respirations are 42/min. Physical examination shows mild respiratory distress. An x-ray of the chest shows hyperinflation with infiltrates in the right middle and right lower lobes of the lung. During hospitalization, the patient has greasy bowel movements with a pungent odor. A sweat chloride test confirms the diagnosis, and the patient is started on a special formula with oral supplementation of fat-soluble vitamins. If the incidence of this genetic disease is 1/2500 among whites, which of the following is the approximate carrier frequency of this mendelian trait in this population?
A ) 1/12
B ) 1/25 - q^2 = 1/2500 --> q = 1/50 --> for heterozygotes (carriers) 2q --> 2/50 = 1/25
C ) 1/50
D ) 1/125
E ) 1/625

q5
3. A 4-year-old boy is brought to the physician by his parents because of global developmental delays and odd behaviors such as hand flapping. His mother has a learning disability, and his maternal uncle has mental ******ation. Physical examination shows macrocephaly, large ears, and a prominent chin. He has a 3-word vocabulary. A diagnosis of fragile X syndrome is made. After the parents are informed of the results, they ask if their healthy 12-year-old daughter, who has met all developmental milestones, should be tested to determine her carrier status. Which of the following responses by the physician is most appropriate?
A ) "I recommend testing her now so that she can be prepared for what may lie ahead if she has children."
B ) "I recommend waiting until she is older and mature enough to decide for herself if she would like to be tested." (I think)C ) "It would be better if she were at least 16 years of age, closer to her childbearing years, before testing was initiated."
D ) "Let's discuss the situation with her, review the pros and cons of testing, and then ask her if she would like to be tested now."
E ) "Let's hold off on that and discuss the options with her when she is planning to marry and have children."

q6
A 45-year-old woman comes to the physician because of a 6-month history of mouth ulcers, thickening of the skin, and throbbing pain in her hands when they are exposed to the cold. She also has had a 1-month history of severe headaches and difficulty swallowing. Physical examination shows small red lesions around the mouth and generalized muscle weakness. Laboratory studies show a high titer of anti-Scl 70 (anti-topoisomerase I) antibody. A biopsy specimen of the skin shows thinning of the epidermis, hyalinization and obliteration of arterioles, and dermal thickening. These dermatologic changes are caused primarily by the release of chemokines from which of the following inflammatory cell types?
A ) Endothelial cells
B ) Eosinophils
C ) Lymphocytes
D ) Mast cells
E ) Platelets
F ) Segmented neutrophils

Answers in bold. Please correct me if I made a mistake
 
nothing?? guys plz!🙁
If you want your questions answered, I suggest posting them like as above. It not only makes them easier to answer but also you can see them in context.
Just my 2 cents 🙂
 
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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
D) Renal carcinoma
E) Renal vein thrombosis
 
THere was a question in this NBME asking about how CO2 is carried.

I picked in RBCs....isnt that right? I got that wrong?

I thought CO2 was carried a HCO3 in RBC.
I got that wrong too. What's the right answer ?

Note: I guess HCO3 is not carried in RBC since it diffuses out of RBC's after CA converts CO2 to HCO3.
 
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and the answer to custard pie question is Staph aureus since that's the only heat stable toxin among the choices?
 
Bacterial strain X is resistant to Ampicillin and sensitive to Gentamicin. Bacterial strain Y is resistance to gentamicin and sensitive to Ampicillin. Bacterial strain X and Y are grown in mixed culture in medium without antibiotics, then the culture is plated on medium containing both ampicillin and gentamicin. Bacterial colonies grow on the plate. In a second experiment DNase is added to a mixed culture medium. When this mixed culture is plated on medium containning both antibiotics ,no colonies grow. Assuming that bacterial cells are impermeable to DNase, which of the following processes best explain these observations?

A- Conjugation
B- Mutation
C- Transduction
D- Transformation
E- Transposition
 
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
D) Renal carcinoma
E) Renal vein thrombosis

Maybe D?, RCC secretes ectopic EPO which will account for the high hematocrit, the slightly elevated BUN and the rbc in the urine.
 
Bacterial strain X is resistant to Ampicillin and sensitive to Gentamicin. Bacterial strain Y is resistance to gentamicin and sensitive to Ampicillin. Bacterial strain X and Y are grown in mixed culture in medium without antibiotics, then the culture is plated on medium containing both ampicillin and gentamicin. Bacterial colonies grow on the plate. In a second experiment DNase is added to a mixed culture medium. When this mixed culture is plated on medium containning both antibiotics ,no colonies grow. Assuming that bacterial cells are impermeable to DNase, which of the following processes best explain these observations?

A- Conjugation
B- Mutation
C- Transduction
D- Transformation
E- Transposition

Found the answer on another forum:

Tranformation is the most likely event that occurred.

First there were some ampR bacteria and some GentaR bacteria. When co-cultured, there are always some bacteria dying (and thus spilling their cellular contents into the medium) and bacteria have this tendency to pick up extraneous pieces of DNA from the medium. This is transformation. So some Genta resistant bacteria picked up some AmpR or vice versa. This happens very often. So when this culture was then plated on Amp+Genta media, a few of them that had taken up the useful pieces of DNA from the medium had what it takes to survive.

Lets see the conditions mentioned again. DNAase was added to the media in which they were grown without antibiotics. (When any bacteria died and spilled their insides into the media, their DNA was destroyed. So other bacteria did not have a chance to take up any useful extraneous DNA. AmpR bacteria could not pick up GentaR DNA, GentaR bacteria could not pick up any AmpR DNA). No transformation took place. And when this mixture was plated on media with both antibiotics, there were no bacteria that could survive the challenge.
 
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