NBME Practice Questions

[envelope]

Could anyone help me out with these?

11. Which is the likely consequence of impaired synthesis of Il-1

a. enhanced phagocytic activity of macrophages
b. enhanced production of antibody by B lymphocytes
c. impaired antigen processing by macrophages
d. impaired function of T lymphocytes
e. impaired production of leukotrienes by neutrophils

36. A clone of cancer cells is resistant to vincristine, doxorubicin, and dactinomycin but not to methotrexate and various alkylating agents. The mechanism of resistance involves

a. absence of superoxide dismutase
b. altered DNA polymerase
c. enhanced drug transport out of cell
d. inability to form polyglutamates
e. increased Dnase

30. A 5 year old boy with recurrent ear infection history receives his preschool booster immunization against diptheria, tetanus, pertussis. He is participating in a community sponsored study to determine the humoral immune response to tetanus toxoid (tt). His response is well below normal for age and sex matched children. Peripheral B lymphocyte count and T cell count and function are within the reference range. The antibody he makes is positive in both the passive hemagglutination and complement mediated lysis of tt-coated erythrocytes. His antibodies do not opsonize tt-coated latex particles for phagocytosis and do not directly precipitate tt efficiently. This child has a defect in

a. affinity maturation of immunoglobulins
b. immunoglobulin isotype switching
c. recombination of heavy chain variable region genes
d. recombination of light chain variable region genes
e. somatic mutation of immunoglobulin genes

7. A pharmaceutical company has developed a drug that prevents egress of Mg2+ from the NMDA receptor. What is the most likely effect of this rug in a patient with an acute stroke?

a. decreased risk for seizures due to hypomagnesemia
b. facilitation of Ca2+ entry into neuron and enhancement of excitotoxin-mediated cell death
c. hyperpolarization of membrane and counduction block
d. prevention of Ca2+ entry into neuron and reduction of excitotoxin-mediated cell death
rapid depolariziation of membrane with lowering of the seizure threshold

22. A 25 yo woman has generalized bone pain for 9 years. She has frequent episodes of loose bulky stools. Examination shows muscle weakness and distended abdomen. X ray films show generalized demineralization of bones, absence of lamina dura, and fracture like lines in the feet bones. What happens to Ca, Phosphorus, AP, and PTH?

26. A 62 yo man is brought to the doctor for evaluation of 6 mo history of progressively strange behavior. He has been impulsive and distractible, has stopped bathing and combing his hair. He is rude and unkempt. Occasionally, while eating he has stuffed food into this mouth with his fingers. He has mild problems with memor. His only medical problem is a 1 year history of htn controlled by atenolol. Neuro exam shows no focal signs but the grasp and snout reflexes are prominent.

a. arteriosclerosis
b. dementia, alzheimer’s type
c. huntington’s
d. normal aging
e. pick’s disease

33. A 55 yo man with patchy leukoplakia on anterior floor of mouth for 4 years. He now has a raised, firm white lesion in the same area. Examination of tissue obtained on biopsy of this new lesion is most likely to show

a. aphthous ulcer
b. burkitt’s lymphoma
c. candida
d. kaposi’s sarcoma
e. mixed parotid gladn tumor
f. squamour cell carcinoma
g. warthin’s tumor

41. A 4-year old girl is brought to the emergency department because of a 5-day history of fever, diffuse abdominal pain, nausea, vomitting, and diarrhea. Examination shows petechiae, hepatomegaly, and splenomegaly. Hemoglobin concentration is 8.7 g/dL and platelet count is 60,000/mm3. A perpheral blood smear shows erythrocyte fragmentation. Which of th following renal findings is most likely to be associated with her condition?
A) Glomerular crescent formation
B) IgG-associated glomerular basement membrane antibody
C) Membranoproliferative glomerulonephritis
D) Narrowing of the capillary wall by fibrin deposition
E) Periglomerular granuloma with giant cells

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[Idiopathic]

These all look pretty classic. 10 minutes with a path book should answer every one of these.

 

[BlackNDecker]

These all look pretty classic. 10 minutes with a path book should answer every one of these.

Agreed...

However, envelope, if you suggested your rationale for each of the answers people might be more inclined to discuss them with you. As it stands, it sounds like you're asking someone to do your homework for you.

 

[envelope]

Not sure of my answers

11. Which is the likely consequence of impaired synthesis of Il-1

a. enhanced phagocytic activity of macrophages
b. enhanced production of antibody by B lymphocytes
c. impaired antigen processing by macrophages
d. impaired function of T lymphocytes
e. impaired production of leukotrienes by neutrophils

D. Il-1 is secreted by Macrophages and stimulates T cells and also produces fever. However in First Aid it mentions Neutorophils are also stimulated. But i'm not sure of leukotrienes are produced by Neutrophils.

36. A clone of cancer cells is resistant to vincristine, doxorubicin, and dactinomycin but not to methotrexate and various alkylating agents. The mechanism of resistance involves

a. absence of superoxide dismutase
b. altered DNA polymerase
c. enhanced drug transport out of cell
d. inability to form polyglutamates
e. increased Dnase

C. Drug transport out of the cell is a standard mechanism of resistance but why would it be selective to non alkylating agents?

30. A 5 year old boy with recurrent ear infection history receives his preschool booster immunization against diptheria, tetanus, pertussis. He is participating in a community sponsored study to determine the humoral immune response to tetanus toxoid (tt). His response is well below normal for age and sex matched children. Peripheral B lymphocyte count and T cell count and function are within the reference range. The antibody he makes is positive in both the passive hemagglutination and complement mediated lysis of tt-coated erythrocytes. His antibodies do not opsonize tt-coated latex particles for phagocytosis and do not directly precipitate tt efficiently. This child has a defect in

a. affinity maturation of immunoglobulins
b. immunoglobulin isotype switching
c. recombination of heavy chain variable region genes
d. recombination of light chain variable region genes
e. somatic mutation of immunoglobulin genes

B. not sure why...hyper IgM?

7. A pharmaceutical company has developed a drug that prevents egress of Mg2+ from the NMDA receptor. What is the most likely effect of this rug in a patient with an acute stroke?

a. decreased risk for seizures due to hypomagnesemia
b. facilitation of Ca2+ entry into neuron and enhancement of excitotoxin-mediated cell death
c. hyperpolarization of membrane and counduction block
d. prevention of Ca2+ entry into neuron and reduction of excitotoxin-mediated cell death
rapid depolariziation of membrane with lowering of the seizure threshold

D. makes the most sense...

22. A 25 yo woman has generalized bone pain for 9 years. She has frequent episodes of loose bulky stools. Examination shows muscle weakness and distended abdomen. X ray films show generalized demineralization of bones, absence of lamina dura, and fracture like lines in the feet bones. What happens to Ca, Phosphorus, AP, and PTH?

Lack of vitamin D. Ca decrease, Phosphorus decrease (cuz can't absorb them from the intestinal tract which is controlled by vitamin D), AP increase (increased bone resporbtion), PTH increase.

26. A 62 yo man is brought to the doctor for evaluation of 6 mo history of progressively strange behavior. He has been impulsive and distractible, has stopped bathing and combing his hair. He is rude and unkempt. Occasionally, while eating he has stuffed food into this mouth with his fingers. He has mild problems with memor. His only medical problem is a 1 year history of htn controlled by atenolol. Neuro exam shows no focal signs but the grasp and snout reflexes are prominent.

a. arteriosclerosis
b. dementia, alzheimer’s type
c. huntington’s
d. normal aging
e. pick’s disease

B.

33. A 55 yo man with patchy leukoplakia on anterior floor of mouth for 4 years. He now has a raised, firm white lesion in the same area. Examination of tissue obtained on biopsy of this new lesion is most likely to show

a. aphthous ulcer
b. burkitt’s lymphoma
c. candida
d. kaposi’s sarcoma
e. mixed parotid gladn tumor
f. squamour cell carcinoma
g. warthin’s tumor

F. Leukoplakia can lead to squamous cell carcinioma.


41. A 4-year old girl is brought to the emergency department because of a 5-day history of fever, diffuse abdominal pain, nausea, vomitting, and diarrhea. Examination shows petechiae, hepatomegaly, and splenomegaly. Hemoglobin concentration is 8.7 g/dL and platelet count is 60,000/mm3. A perpheral blood smear shows erythrocyte fragmentation. Which of th following renal findings is most likely to be associated with her condition?
A) Glomerular crescent formation
B) IgG-associated glomerular basement membrane antibody
C) Membranoproliferative glomerulonephritis
D) Narrowing of the capillary wall by fibrin deposition
E) Periglomerular granuloma with giant cells

DIC or some kind of bleeding/rbc disorder...i would guess A cuz it is rapid progression of disease. Not B cuz that is Goodpasture's and not C because that doesn't usually occur in kids....

 

[marcusab]

Anyone know the answer to question #41 in the original post? I'm having trouble finding this in robbins.

Here it is:

41. A 4-year old girl is brought to the emergency department because of a 5-day history of fever, diffuse abdominal pain, nausea, vomitting, and diarrhea. Examination shows petechiae, hepatomegaly, and splenomegaly. Hemoglobin concentration is 8.7 g/dL and platelet count is 60,000/mm3. A perpheral blood smear shows erythrocyte fragmentation. Which of th following renal findings is most likely to be associated with her condition?
A) Glomerular crescent formation
B) IgG-associated glomerular basement membrane antibody
C) Membranoproliferative glomerulonephritis
D) Narrowing of the capillary wall by fibrin deposition
E) Periglomerular granuloma with giant cells


I'm working on NBME b/c qbank is down.

 

[marcusab]

I think this is TTP, which has a component of renal insufficiency, fibrin clots so I'm answering D.

 

[Catalyst]

i think it's e.coli 0157:H7 or shigella causing hemolytic uremic syndrome with the triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal failure... this would point to answer D because fibrin gets deposited in the glomerular capillaries

 

[Idiopathic]

#11 - e (I go with e because IL-1 is all about the acute phase, and while it may affect T cell function down the line, it is more about affecting fever, edema, and neutrophil activity)

#36 - c (i would go with b, but vincristine does not affect DNA polymerase directly)

#30 - a (i think this is CVID...not SCID, px would have abnormal Ab levels and probably be dead. I think this is like an IgG subclass deficiency, which results from poor affinity maturation. My kid had this, which is how I am familiar with it)

#7 - d (remembr Mg blocks the opening and glutamate [i think] opens the channel alowing Ca++ in)

#26 - e (this is Pick's disease. the primitive reflexes, inappropriate behavior out of proportion with the memory loss. not alzheimers)

#33 - f (under the tongue/floor of mouth most common site fo oral cancer as per goljan [i think])

#41 - d (this sounds like HUS to me, where the capillaries get obstructed by the clots. i guess its similar to DIC in that, but I dont think of it as an RPGN)

 

[Idiopathic]

i think it's e.coli 0157:H7 or shigella causing hemolytic uremic syndrome with the triad of microangiopathic hemolytic anemia, thrombocytopenia, and renal failure... this would point to answer D because fibrin gets deposited in the glomerular capillaries

Correct it looks like HUS. Remember poor cooking of hamburger meat, young kids, renal failure, PETECHIAE!!!

 

[marcusab]

hey, thanks catalyst and idiopathic

Correct it looks like HUS. Remember poor cooking of hamburger meat, young kids, renal failure, PETECHIAE!!!