Nbme 7

[jellyfish]

Hey SDN, Is there anyone whose taken the test taken the NBME 7? I looked around and since the test is so new there isn't much information on it. I just took it today, and wanted to get some feedback on how it compared to the real thing, and predicted your scores?

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[mayn]

I guess it looks like the Phe -> Tyrosine -> NE pathway

Well that's more dopamine/cathecholamine synthesis pathway right.. I was thinking de novo synthesis for all the non essential AA's (other than PVT TIM HALL), like glycine, proline etc

Really wish I had an answer for this, my step 1 is coming up in 5 days.

 

[ZGX]

Well that's more dopamine/cathecholamine synthesis pathway right.. I was thinking de novo synthesis for all the non essential AA's (other than PVT TIM HALL), like glycine, proline etc

Really wish I had an answer for this, my step 1 is coming up in 5 days.

I couldn't find what you were looking for (the pathway). I'll keep searching.

As far as I know, NBME 7 was released around December 2009. While 11, 12,13 are more later and tend to reflect the actual exam itself.

 

[mayn]

haha damn.. I got a crazy high dream score on this one. I hope this isn't too 'off' from the actual thing.

Thanks for searching though, it's cool if nothing comes up. Earlier I tried googling this particular question was discussed on other forums, didn't really find anything useful.

 

[Phloston]

I also picked D for the amino acid biosynthesis question. Gd knows how that is wrong. Pretty ******ed if you ask me.

Well since D and A are apparently both wrong, the answer must be B.

I'm guessing the idea is that the most distal product in a particular pathway inhibits the formation of the first product of that unique pathway.

1 and 2 are shared between both pathways, so 5 cannot exert full control over A.

So 7 inhibits E and 5 inhibits B.

Once again, a full applause to the NBME for most ******ed question of the century award.

 

[MLT2MT2DO]

Bumpage.


Measurement of which of the following would provide the most definitive evidence for normal thyroid function:

TSH
FT4
Iodine/Iodide
TSH
TT4
TT3

I don't understand why it isn't FT4, "unofficial" keys say "TSH", but for a definitive diagnosis of the thyroid wouldn't FT4 be more specific therefore more definitive?

 

[lira126]

TSH is a more sensitive lab marker of any abnormal thyroid function. Measurable changes in TSH occur before measurable changes in FT4 occur.

 

[MLT2MT2DO]

TSH is a more sensitive lab marker of any abnormal thyroid function. Measurable changes in TSH occur before measurable changes in FT4 occur.

Is that just because there's more TSH in the body overall? TSH works by feedback from FT4, so wouldn't it make sense that FT4 would drop first?

 

[NickNaylor]

Is that just because there's more TSH in the body overall? TSH works by feedback from FT4, so wouldn't it make sense that FT4 would drop first?

TSH levels allow you to differentiate the etiology (e.g., primary vs. secondary) as well as the type of dysfunction all in one. I agree that it seems counterintuitive (it took a couple of questions of missing this stuff before it stuck for me) but it makes sense in terms of best bang for your buck if you're only ordering one test.

Sent from my Nexus 7

 

[Smashingdude]

Hey, anyone has figured out the last question regarding free energy and reaction?
I.e 2 reactions are given with their free energy (G):

A=B+C G=-11.1 kcal/mol
C+D=E G=+6.4 Kcal/mol

We are ask to find the G and the direction for the following reaction:

A+D->E+B
<-

Thanks

 

[withrye]

Hey, anyone has figured out the last question regarding free energy and reaction?
I.e 2 reactions are given with their free energy (G):

A=B+C G=-11.1 kcal/mol
C+D=E G=+6.4 Kcal/mol

We are ask to find the G and the direction for the following reaction:

A+D->E+B
<-

Thanks

If you straight add those reactions, reagent C drops out by virtue of being on both sides. The answer should be -4.7.

I haven't done this Nbme, so I don't know for sure.

 

[Smashingdude]

Thanks..But does anyone know the real answer from extended form? Because, I am getting all kinds of answers from the forums for this one.

Here were the answer choices (1-Reaction to the right; 2-Reaction to the left):

&#916;G&#730; direction
A) +17.5 1
B) +17.5 2
C) -4.7 1
D) -4.7 2
E) -17.5 1
F) -17.5 2

 

[withrye]

To the right, because you haven't changed directionality when you summed the equations.

 

[MLT2MT2DO]

Thanks..But does anyone know the real answer from extended form? Because, I am getting all kinds of answers from the forums for this one.

Here were the answer choices (1-Reaction to the right; 2-Reaction to the left):

&#916;G&#730; direction
A) +17.5 1
B) +17.5 2
C) -4.7 1
D) -4.7 2
E) -17.5 1
F) -17.5 2

It's C

 

[Jonari]

It's C

can you explain how to do this, please? i had one my CBSE...and i hate gibbs equation questions...i feel these are easy points but im overcomplicating it...thanks

 

[Smashingdude]

I think I have figured it out...Here is how I work on it:

A->B+C G=-11.1
C+D->E G=+6.4

So, lets look at first equation :
A--------------------> B+C And for this reaction G=-11.1
Means <------------------ is G=+11.1

2nd Equation:
C+D------------------------>E G=+6.4
<----------------------- G=-6.4

Now, add them:

A+C+D -----------------------------------------> B+C+E G=-11.1+6.4 = -4.7
<---------------------------------------- G=+11.1-6.4 = +4.7

Therefore, the natural tendency for the reaction is to go RIGHT (cause G is -ve, means the products are preferred over substrate)

It can't be to the LEFT, since that is NOT A SPONTANEOUS reaction i.e. you will need to supply +4.7 kcal for the reaction to proceed in that direction.

I hope its clear now, and it helps.

 

[Smashingdude]

Sorry for the mishap in writing. I tried my best to align them but I guess in the text box, it all just jumbled up

The two arrows are indicating a reversible reaction. The energy in the opposite direction, is the opposite of the delta G given for the reaction.

 

[MedicineMike]

My exam is in 6 days and this is the only NBME I have left. Should I give it a shot? Is it worthwhile?

 

[dragon529]

I just took this today and it hit some good review topics. If you can spare 4 hrs then go for it!

 

[MedicineMike]

I just took this today and it hit some good review topics. If you can spare 4 hrs then go for it!

I guess I'm just worried I'll do bad and freak out - still on my high from my UWSA 1

 

[Jonari]

My exam is in 6 days and this is the only NBME I have left. Should I give it a shot? Is it worthwhile?

yes...6 days take it tomorrow...and whatever you've missed review it for the next 3 days...

UWSAs are known to be over predicting...

 

[MedicineMike]

yes...6 days take it tomorrow...and whatever you've missed review it for the next 3 days...

UWSAs are known to be over predicting...

Well, I took it. Thought I'd improve by now but I guess not. crap

 

[coolforschool]

Well, I took it. Thought I'd improve by now but I guess not. crap

I thought it was one of the harder ones, FWIW. I scored 20-25 pts. less on it than I did for the more recent ones I took. A lot of things that were out of my control played into that though, which only highlights the importance of "being in the zone" for the actual exam. Good luck, dude. I take mine soon too.

 

[sharklasers]

Is this still the discussion thread?

What was the one with the brain MRI and the left homonymous hemianopsia?

I think the answer is the one pointing to the occipital lobe, but this would DEFINITELY lead to macular sparing. I chose the one that looked like it might have been pointing to the left optic tract. Thanks!

 

[JP2740]

The question abut the 44 year old dude with HIV, who had an acid fast diarrhea. That was crypto right? I accidentally put entamoeba like an idiot, but just want to make sure I got the right answer.

 

[sharklasers]

The question abut the 44 year old dude with HIV, who had an acid fast diarrhea. That was crypto right? I accidentally put entamoeba like an idiot, but just want to make sure I got the right answer.

I think so!

 

[sharklasers]

BUMP


I had a question on the one where the guy has ipsilateral loss of facial sensation, ataxia and contralateral loss of sesnation in the trunk and extremitie. It asks which vessel was infarcted...

Anterior Inferior cerebellar
Basilarh
Pontine
Posterior Inferior cerebellar
Superior cerebellar.


Which is it?

And man, i did horrible on biochem, despite having a decent biochem average in UW...what did everyone else think about the biochem?

can someone explain this one again?

the picture clearly shows a medulla, which I didn't recognize (thought it was the pons), so I tried to rely on the clinical presentation.

Couldn't lateral pontine syndrome and lateral medullary syndrome give you the symptoms mentioned in the question?

and medullary syndrome would give you dysphagia or a decreased gag reflex while lateral pontine syndrome would give you facial paralysis, etc.

thanks!

 

[pvtbacon]

can someone explain this one again?

the picture clearly shows a medulla, which I didn't recognize (thought it was the pons), so I tried to rely on the clinical presentation.

Couldn't lateral pontine syndrome and lateral medullary syndrome give you the symptoms mentioned in the question?

and medullary syndrome would give you dysphagia or a decreased gag reflex while lateral pontine syndrome would give you facial paralysis, etc.

thanks!

I haven't taken this form yet but based on the lesions I can only think of Lateral pontine syndorme.

Ipsi face - spinal nucleus/tract of V
ataxia - Middle cerebellar peduncle
loss of contralateral sensation from limbs - medial lemniscus

If i remember correctly, the lateral pons was supplied by AICA, otherwise i'm screwed for the test on friday

 

[JP2740]

One is about the 61 year old dude who came in with aortic dissection and had some scans on the question. It said what is he at greatest risk for?:
a. aortic stenosis (I put this which was wrong, but I know dissections can cause this)
b. cardiac tamponade (first aid says this is a risk)
c. mitral insufficiency (this is tempting to me... because the question said he had decreased breath sounds at the base... Idk)

 

[pvtbacon]

One is about the 61 year old dude who came in with aortic dissection and had some scans on the question. It said what is he at greatest risk for?:
a. aortic stenosis (I put this which was wrong, but I know dissections can cause this)
b. cardiac tamponade (first aid says this is a risk)
c. mitral insufficiency (this is tempting to me... because the question said he had decreased breath sounds at the base... Idk)

Given these three choices, best answer would be hemopericardium and tamponade. Aortic dissection puts him at risk for aortic rupture and bleeding into the pericardial sac.

 

[sharklasers]

One is about the 61 year old dude who came in with aortic dissection and had some scans on the question. It said what is he at greatest risk for?:
a. aortic stenosis (I put this which was wrong, but I know dissections can cause this)
b. cardiac tamponade (first aid says this is a risk)
c. mitral insufficiency (this is tempting to me... because the question said he had decreased breath sounds at the base... Idk)

its tamponade

did you get the mri and homonymous hemianopsia one? its bothering me so much that they had the lesion at the cortext but clearly didn't say that there was macular sparing

 

[sharklasers]

I haven't taken this form yet but based on the lesions I can only think of Lateral pontine syndorme.

Ipsi face - spinal nucleus/tract of V
ataxia - Middle cerebellar peduncle
loss of contralateral sensation from limbs - medial lemniscus

If i remember correctly, the lateral pons was supplied by AICA, otherwise i'm screwed for the test on friday

the picture might be the onyl thing that is supposed to give it away then lol, it was a picture of the medulla so that = PICA

 

[JP2740]

its tamponade

did you get the mri and homonymous hemianopsia one? its bothering me so much that they had the lesion at the cortext but clearly didn't say that there was macular sparing

The only choice that made sense was in the occipital lobe. I know it has macular sparing but you are thinking too deeply into it. That's what people warned us about on this board so I just tried to keep it simple. Plus, there was only 1 other letter that was labelled on the correct side of the picture (th others would've given the oppisite side hemianopsia), and I think that was in the internal capsule. but I don't remember

 

[JP2740]

the picture might be the onyl thing that is supposed to give it away then lol, it was a picture of the medulla so that = PICA

The picture was of the lateral medulla which you knew it was that by the pyramids at the bottom of the pic, but the lateral medullary syndrome is ipsi face, contra body - NO OTHER neuro lesion will give you this. Bam you know what it is immediately if you see this.

 

[pvtbacon]

the picture might be the onyl thing that is supposed to give it away then lol, it was a picture of the medulla so that = PICA

gg

 

[coolforschool]

its tamponade

did you get the mri and homonymous hemianopsia one? its bothering me so much that they had the lesion at the cortext but clearly didn't say that there was macular sparing

The other arrows were pointing to the caudate, internal capsule, lenticular nucleus and temporal lobe. You're not at the level of the eyes, so it's probably not likely that the arrow was pointing to the optic tract.

 

[sharklasers]

In the one with the kid with glucose-6-phosphate deficiency, why did symptoms occur 3-4 hours after feeding?

Everything else points to Glucose 6 phosphate deficiency, but the 3-4 hours after feeding through me off. I chose galactose-1-phosphate uridyltransferase... but should have known that cataracts would definitely be a feature if a question abotu that is asked

 

[sharklasers]

The other arrows were pointing to the caudate, internal capsule, lenticular nucleus and temporal lobe. You're not at the level of the eyes, so it's probably not likely that the arrow was pointing to the optic tract.

Oh true... damn that is a dumb one to miss...

I just completely ruled out the occipital lobe since it didn't say macular sparing, and then randomly guessed after that.

i guess this was a "choose the best answer" one, even though i guess technically all of the answer were wrong...

 

[JP2740]

In the one with the kid with glucose-6-phosphate deficiency, why did symptoms occur 3-4 hours after feeding?

I don't even remember this question lol can you post it

 

[pvtbacon]

In the one with the kid with glucose-6-phosphate deficiency, why did symptoms occur 3-4 hours after feeding?

3-4 hours (after meal fasting) is when hepatic gluconeogenesis glycogenolysis and gluconeogenesis kicks in. The enlarged liver, lactic acidosis, and fasting hypoglycemia is textbook for von gierke

 

[coolforschool]

The picture was of the lateral medulla which you knew it was that by the pyramids at the bottom of the pic, but the lateral medullary syndrome is ipsi face, contra body - NO OTHER neuro lesion will give you this. Bam you know what it is immediately if you see this.

Lateral medullary and lateral pontine syndrome can both produce ipsi face, contra body. The difference is that lateral medullary = CN X while lateral pontine (higher up) = CN VII/VIII.

The question made you look at the picture and make the diagnosis based on the presence of the medulla and not from the vignette. This is probably how Step is going to be... it's about the best possible answer and not about telling you every single lesion defect in the stem. Get used to it 'cause I've seen some horrible questions haha.

 

[sharklasers]

I don't even remember this question lol can you post it

3 month old, crying and tremulousness 3-4 hours after breast feeding, fat cheeks, massive hepatomegaly, thin extremities. Decreased glucose, increased lactic acid, uric acid, triglycerides upon 4 hour fast. What enzyme is deficient?

Pretty dumb mistake on my part, I get why I got it wrong. Just the 3-4 hours after feeding problems confused me. I figured the problems with glucose-6-phosphatase would go away after feeding, since you wouldn't need to break down glycogen?

But I guess maybe the increasing the already high stores is why you have issues with feeding?

 

[sharklasers]

Lateral medullary and lateral pontine syndrome can both produce ipsi face, contra body. The difference is that lateral medullary = CN X while lateral pontine (higher up) = CN VII/VIII.

The question made you look at the picture and make the diagnosis based on the presence of the medulla and not from the vignette. This is probably how Step is going to be... it's about the best possible answer and not about telling you every single lesion defect in the stem. Get used to it 'cause I've seen some horrible questions haha.

yeah i hadn't seen brainstem cross sections since m1 and got it wrong

i'm surprised uworld doesn't have a single question regarding brainstem cross sections..

 

[coolforschool]

yeah i hadn't seen brainstem cross sections since m1 and got it wrong

i'm surprised uworld doesn't have a single question regarding brainstem cross sections..

I actually took Phloston's advice and zoomed through Kaplan's sections. It took under an hour. I still don't remember a lot but hopefully I'll be able to recognize some on Friday. My friend said there wasn't much neuro for him.

 

[pvtbacon]

I actually took Phloston's advice and zoomed through Kaplan's sections. It took under an hour. I still don't remember a lot but hopefully I'll be able to recognize some on Friday. My friend said there wasn't much neuro for him.

I'm also taking it Friday. What else do you recommend quickly reviewing before the test?

 

[coolforschool]

I'm also taking it Friday. What else do you recommend quickly reviewing before the test?

Man IDK, I'm sort of freaking out about it. Too much material to go over, but I'm just looking through my weakest areas in First Aid. I used the book here and there but never really flipped through the whole thing, so I think that might be the highest yield thing to do for me since I should know a lot of the material in there already. I think the general advice is to solidify micro, pharm, embryo and biochem since they tend to be gimmes/memorization, so that's what I'm doing basically. I have my pharm and micro cards at the helm for tomorrow, gonna blaze through 'em.

 

[computernerd225]

Can anyone tell me what the correct answer is to the question about the 30 year old male with HIV who had a rash for 3 weeks? It gives you a picture of the lesion and says he doesn't have it on his palms and soles.



Answer choices:
Herpes
HPV infection
Kaposi Sarcoma
Molluscum contagiosum
Rickettsia infection
Syphilis
VZV infection

I picked HPV because it looked like a wart but it was wrong. None of the other answer choices look correct though.

 

[MLT2MT2DO]

Can anyone tell me what the correct answer is to the question about the 30 year old male with HIV who had a rash for 3 weeks? It gives you a picture of the lesion and says he doesn't have it on his palms and soles.



Answer choices:
Herpes
HPV infection
Kaposi Sarcoma
Molluscum contagiosum
Rickettsia infection
Syphilis
VZV infection

I picked HPV because it looked like a wart but it was wrong. None of the other answer choices look correct though.

That's a picture perfect case of Molluscum cantagiosum

 

[computernerd225]

Ah okay.

I was looking for something like this for molluscum

I didn't see any areas of depression on that lesion.

Thanks!

 

[sharklasers]

Yeah I thought they could have chosen a better picture too, I looked at it and thought I could kind of see a depression on the one on the left, so chose molluscum. I guess the uniform color and shape would also kind of point you away from some of the other choices and towards molluscum.

 

[CaliAtenza]

sorry to bring up this thread again, but the question about the lady that had breast cancer, from which she died later on...in addition, her mother and one of her sisters had also died from breast cancer. I would have picked answer choice A, which was amplification of the HER2 gene in somatic cells. Apparently the right answer is E, germline inactivation of the BRCA1 gene. Is E correct because the carcinoma was well differentiated?