Official nbme 15 discussion

[abelabbot]

A new NBME 15 is out! Here is the official discussion page. How did you guys feel about this nbme?

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[Kanye West]

"A 2-month-old male infant is brought to the emergency department by his mother because of a 2-day history of generalized tonic-clonic seizures, myoclonus, and hiccuping. His mother says he has fed poorly and has been floppy since birth. Physical examination shows decreased deep tendon reflexes and hypotonia. A signaling defect in an inhibitory neurotransmitter is suspected. Which of the following neurotransmitter receptors most likely contains the defect?"



I just read the question about the floppy baby... I initially thought about a listless baby, so maybe he ingested canned goods or honey that contained botulinum toxin - pointing towards a neuromuscular junction issue (acetylcholine)... but then again the vignette says that the baby had tonic-clonic seizures... which leads more towards something like tetany (Glycine or GABA)... and maybe the reason why the baby's floppy is because it's always so tired??

Why would the vignette point to two different things? do we get questions like that on the actual step... or am I the only one viewing the question that way....

When I saw floppy, I thought of botulism too...but the stem said which inhibitory neurotransmitter is blocked...leading you to tetanus

For some reason I confused GABA and glutamate. The fact that they said inhibitory neuron actually makes the question really easy. It has to be glycine or GABA.

 

[Pudge115]

"A 2-month-old male infant is brought to the emergency department by his mother because of a 2-day history of generalized tonic-clonic seizures, myoclonus, and hiccuping. His mother says he has fed poorly and has been floppy since birth. Physical examination shows decreased deep tendon reflexes and hypotonia. A signaling defect in an inhibitory neurotransmitter is suspected. Which of the following neurotransmitter receptors most likely contains the defect?"



I just read the question about the floppy baby... I initially thought about a listless baby, so maybe he ingested canned goods or honey that contained botulinum toxin - pointing towards a neuromuscular junction issue (acetylcholine)... but then again the vignette says that the baby had tonic-clonic seizures... which leads more towards something like tetany (Glycine or GABA)... and maybe the reason why the baby's floppy is because it's always so tired??

Why would the vignette point to two different things? do we get questions like that on the actual step... or am I the only one viewing the question that way....

So according to wikipedia, glycine is inhibitory in the spinal cord and brainstem, while excitatory in cortex. The kid probably has glycine encephalopathy, which is a defect in glycine metabolism with elevated glycine in the CNS, leading to infantile hypotonia, seizures, mental ******ation, brain malformation.

 

[mastmastdonan]

Does anyone where I can find this offline? I really want to go through the whole test again, not just my wrong answers. Taking my exam on Saturday, so a quick review of NBME 15 would be super helpful... PM me please if you know where I can find it.

 

[painmd87]

I've done NBME 6, 7, 12, 15, as well as both UWorld SAs

I felt the absolute worst after taking NBME 15, but scored the best out of all of them. This one by far had the most bizarre questions out of what I've seen from the NBME. Probably 3-4 questions that were word-for-word in UWorld, and another 2 that were on the NBME micro and/or pharm shelf exams.

Really hoping that a "find the mean from this set of 10 numbers" pops up on the real thing... not sure I could handle that...

As for the SF/NY/PA virus recombination question, I can go ahead and do without them in two weeks.

 

[Smashingdude]

Just took NBME 15. 252/19 incorrect. I was hoping for 260, but I made some silly mistakes...Anyway, on to questions:

1. Whats the risk of fetus if the mom is on Cocaine? I chose Heart Defect, but it was wrong.

2. Anyone managed to do the NY/SF question? I sure crapped my pants when I saw it I have the data for it, so if anyone wants to solve it, let me know. Cant post it here, copyright problems I guess.

3. Concentration of Insulin in DM2 . This was a silly mistake, it suppose to be high, ..I wanna know if it is 40 or 80.

4. I think this one we know from the above discussion..OGP poisoing, first thing after Airway securing is Atropine, not Pralidoxime.

5.Unpasterized cheese, Gram+ cocobacilli. I chose Bacillus cerues, but wrong. I missed the point that it was recovered from Blood. Options are: Camplybacter, Clostridium, Listeria, Ecoli, Salmonella, Staph, Vibrio, Yersinia.

6.Study, for Dextromethorphan use and cough. what limited the validity? I chose "Study location limited to emergency department", but this was wrong. Other options were Limited number of participants; Marginal statistical significance; Lack of blinding between groups; Subjective nature of the study(but this is wrong, in another thread)

7.Pharmacotherapy for GERD. I chose metoclopramide over Omeprazole, but this was obviously wrong. I was thinking metoclopromide will increase the LES tone, and prevent reflux, but apparently its wrong. So the answer has to be omeprazole then. Other options were Cimetidine, sucralfate, Calcium carbonate,

8. Again, another nutcracker, and I feel like an idiot. Down, with symtoms of leukemia. What is seen on BM? I chose Megaloblastosis, since the child is less than 5 year old and is increased risk for M7, but this is wrong. Its sure Excess Lymphoblasts. I guess the distinction of the risk for Down in terms of age is a minor detail, not relavent (i.e. Less than 5 = Risk of M7 , More than 5 year old = Risk of ALL)

9. Huge heart shown. Hx of HTN. I chose Infarct, since there was a red mark under the LV ventricle. But, its wrong. I think it was hypertrophy. The size of the heart is 650g.

10. Kid at 2 month, decreasing Hb/Ht. 3 columns for his CBC at 24hours/1week/1month. I chose congenital CMV infection, wrong again!

11. This was a bummer, since I was so sure its right. Patient has hypokinesia of LV post wall on increasing activity on stress echo. Reason for this finding? I chose "Increased myocardial oxygen consumption". Crap! I think it was "Increased LV end diastolic pressure"

12. Another crapy question. Got shot in abdomen, patient requires decreasing dose of Warfarin 6 weeks later. I chose "Septic shock caused by Ecoli", but wrong!

13. Patient, cries after loss of sister, and then has a headache. I chose "abnormal grief response". I think its "normal emotional response"

14. Female Hx of fever, Lower quadrant pain, Leukocytosis, Increase hcg . Pic shows a cavity, lookling like a mole. I chose "Hydatiform mole", but I think it was Choriocarcinoma, since the entire wall was invaded. Or was it Ectopic?

15. Function of IkB in NF-KB. I know this now, its "Release NFkB after undergoing phosphorylation"

The other 4 were my silly mistakes. G+ve messed up, Teratoma is a Germ cell tumor, not Sex chord etc.

Aright, let me know what you guys answered. If you want to know an answer to some question, let me know and I'll try to remember my response.

Thanks.

 

[stormchao]

Just took NBME 15. 252/19 incorrect. I was hoping for 260, but I made some silly mistakes...Anyway, on to questions:

1. Whats the risk of fetus if the mom is on Cocaine? I chose Heart Defect, but it was wrong. Premature i think

2. Anyone managed to do the NY/SF question? I sure crapped my pants when I saw it I have the data for it, so if anyone wants to solve it, let me know. Cant post it here, copyright problems I guess. HA gene, look at the pattern and notice SF version of gene has a high ratio value, and NY version has low ratio value.

3. Concentration of Insulin in DM2 . This was a silly mistake, it suppose to be high, ..I wanna know if it is 40 or 80. Lowest value. After 30 years of DM her pancreas is done.

4. I think this one we know from the above discussion..OGP poisoing, first thing after Airway securing is Atropine, not Pralidoxime.

5.Unpasterized cheese, Gram+ cocobacilli. I chose Bacillus cerues, but wrong. I missed the point that it was recovered from Blood. Options are: Camplybacter, Clostridium, Listeria, Ecoli, Salmonella, Staph, Vibrio, Yersinia.

6.Study, for Dextromethorphan use and cough. what limited the internal validity? I chose "Study location limited to emergency department", but this was wrong. Other options were Limited number of participants; Marginal statistical significance; Lack of blinding between groups. Obviously if your child isn't getting the drug you will think they have a worse cough. Alot of the other choices were correct reasons why its external validity was invalid, but this was the only internal validity issue. Atleast I remember the question asking something very specific like that. My quick rule for determining external vs internal validity is if you can cover yourself by saying "For a population of children presenting to the emergency department, our results show X". Even by limiting it to that population the not blinding in this question will cause an issue. Hopefully this makes a little bit of sense, it's a bit complicated.; Subjective nature of the study(but this is wrong, in another thread)

7.Pharmacotherapy for GERD. I chose metoclopramide over Omeprazole, but this was obviously wrong. I was thinking metoclopromide will increase the LES tone, and prevent reflux, but apparently its wrong. So the answer has to be omeprazole then. Other options were Cimetidine, sucralfate, Calcium carbonate,

8. Again, another nutcracker, and I feel like an idiot. Down, with symtoms of leukemia. What is seen on BM? I chose Megaloblastosis, since the child is less than 5 year old and is increased risk for M7, but this is wrong. Its sure Excess Lymphoblasts. I guess the distinction of the risk for Down in terms of age is a minor detail, not relavent (i.e. Less than 5 = Risk of M7 , More than 5 year old = Risk of ALL) Yea, Pathoma lead you wrong on this one. It was ALL.

9. Huge heart shown. Hx of HTN. I chose Infarct, since there was a red mark under the LV ventricle. But, its wrong. I think it was hypertrophy. The size of the heart is 650g. I forget

10. Kid at 2 month, decreasing Hb/Ht. 3 columns for his CBC at 24hours/1week/1month. I chose congenital CMV infection, wrong again! Congenital neutropenia. Its lame, but notice how the neutrophils were super low. Atleast I think thats the answer. Hb might be decreasing, but it stays within normal values.

11. This was a bummer, since I was so sure its right. Patient has hypokinesia of LV post wall on increasing activity on stress echo. Reason for this finding? I chose "Increased myocardial oxygen consumption". Crap! I think it was "Increased LV end diastolic pressure" I forget, but your 2nd answer sounds right.

12. Another crapy question. Got shot in abdomen, patient requires decreasing dose of Warfarin 6 weeks later. I chose "Septic shock caused by Ecoli", but wrong! Antibiotic use from gunshot wound leads to decreased gut bacteria leads to decreased vit k production leads to increased PT, thus he would need less warfarin.

13. Patient, cries after loss of sister, and then has a headache. I chose "abnormal grief response". I think its "normal emotional response"

14. Female Hx of fever, Lower quadrant pain, Leukocytosis, Increase hcg . Pic shows a cavity, lookling like a mole. I chose "Hydatiform mole", but I think it was Choriocarcinoma, since the entire wall was invaded. Or was it Ectopic? I got this wrong too, same thinking as you. Pretty sure it was an ectopic. After getting it wrong I realized to just go with the history, and the picture is probably just there to trick you. Looking at the history the first thing I would think is an ectopic

15. Function of IkB in NF-KB. I know this now, its "Release NFkB after undergoing phosphorylation" I dunno, I didn't even care enough to search for the correct answer. Felt this was a low yield question.

The other 4 were my silly mistakes. G+ve messed up, Teratoma is a Germ cell tumor, not Sex chord etc.

Aright, let me know what you guys answered. If you want to know an answer to some question, let me know and I'll try to remember my response.

Thanks.

Answered what I could in bold from memory. I took 15 a little over a week ago and got same score as you, also got alot of the same questions wrong. Good luck.

 

[Smashingdude]

Thank you so much for the input. Really appreciate it. I'll try to solve the SF/NY and see if I manage to crack it.

Just one more thing i forgot.

Crush Injury to the right leg, extensive myonecrosis Gram + rods with few PMN. Is it Bacillus subtilis or Clostridium perfergens? I know the obvious answer is C.Perf, but why are the PMB low?

"Kid at 2 month, decreasing Hb/Ht. 3 columns for his CBC at 24hours/1week/1month. I chose congenital CMV infection, wrong again! Congenital neutropenia. Its lame, but notice how the neutrophils were super low. Atleast I think thats the answer. Hb might be decreasing, but it stays within normal values." I checked the question, and the neutrophils are not super low, they are still in the normal range (5000-19,000). But, if you got it right, then I guess it is neutropenia. I'll read on it later.

Also, one more thing. Internal vs External Validity. I haven't come across these terms anywhere in FA or UW. Could you explain a bit more, or could you recommend me to a link where I can read more about it.

 

[stormchao]

Thank you so much for the input. Really appreciate it. I'll try to solve the SF/NY and see if I manage to crack it.

Just one more thing i forgot.

Crush Injury to the right leg, extensive myonecrosis Gram + rods with few PMN. Is it Bacillus subtilis or Clostridium perfergens? I know the obvious answer is C.Perf, but why are the PMB low?

"Kid at 2 month, decreasing Hb/Ht. 3 columns for his CBC at 24hours/1week/1month. I chose congenital CMV infection, wrong again! Congenital neutropenia. Its lame, but notice how the neutrophils were super low. Atleast I think thats the answer. Hb might be decreasing, but it stays within normal values." I checked the question, and the neutrophils are not super low, they are still in the normal range (5000-19,000). But, if you got it right, then I guess it is neutropenia. I'll read on it later.

Also, one more thing. Internal vs External Validity. I haven't come across these terms anywhere in FA or UW. Could you explain a bit more, or could you recommend me to a link where I can read more about it.

Don't confused leukocytes with neutrophils. If you look at the actual neutrophil % is like 3%. Which is really low. Don't worry, I got it wrong too, so I'm looking at the question right now and the neutrophils are definitely way too low.

C. Perf is the correct answer for the crush injury. I don't really remember the question tho, it was just a knee jerk answer for me. Did it say anything about anerobes/aerobes for it, or that it was producing crepitus or producing gas or anything?

As for external validity vs internal validity I don't have any resources, I don't even know if I ever really learn about it. It just kinda makes sense to me, but then again I like biostats. The best advice I can give when they have these types of questions is to just think about why different studies can be bullcrap, and to what population you can generalize your results to. Internal means an inherent issue with the methods of the study, while an external validity issue would be if they tried to generalize their results to the entire population. They can only say that the drug works for children who visit the emergency room.

 

[CDI]

As for external validity vs internal validity I don't have any resources, I don't even know if I ever really learn about it. It just kinda makes sense to me, but then again I like biostats. The best advice I can give when they have these types of questions is to just think about why different studies can be bullcrap, and to what population you can generalize your results to. Internal means an inherent issue with the methods of the study, while an external validity issue would be if they tried to generalize their results to the entire population. They can only say that the drug works for children who visit the emergency room.

Just came across that (external validity) in UW for CK. Need to check my notes...

 

[orthoengie1315]

Glycine is used in inhibitory interneurons in the spinal cord, so a defect in those receptors would yield the symptoms seen in this vignette.

 

[Jonari]

Following a stroke, a 68 year old man had a language problem. His speech is fluent but contains many grammatical errors, word substitutions, and neologisms. He is unable to repeat words after the examiner and is apparently unable to comprehend other verbal requests. Which area is damaged?

- I assumed that since he was able to speak properly, but couldn't comprehend what was being said to him, this was a problem in Wernike's area. However, it was incorrect.

31. 20 yo is taking recombinant EPO has polycythemia. Question asked which is the most likely cause?
- I recall Sattar or Goljan talking about how EPO causes early release of reticulocytes into the bone marrow. However, it was wrong. Other 3 choices were
b. increase rbc life span - wrong
c. proliferation of bone marrow stem cells - wrong
d. proliferation of erythroid precursors - guess this is right. i do recall somebody stating that EPO causes the stages of RBC production to be shortened in duration. is this the reason for it being correct?

32. question about insecticide poisoning? question asked most appropriate immediate step is administration of what?
- i chose 2-pam, because i know you don't want timing to set in, because once it does, the ability to reform AchE is not possible. however the sentence before the question says she has copious oral secretions. is this the reason why the answer is atropine, instead?

35. 72 year old woman comes in because of acute MI. angiography shows left dominant circulation (misread this), and 90% narrowing of the artery supplying the diaphragmatic surface and the AV node of the heart. what's the direction of the catheter being passed through the heart vessels?
a. left coronary, circumflex, anterior interventricular
b. left coronary, circumflex, posterior interventricular
c. left coronary, poster interventricular
d. right coronary, circumflex, anterior interventricular
e. right coronary, circumflex, poster interventricular
f. right coronary, poster interventricular, circumflex

50. CT scan of the adrenals. patient has elevated blood pressure. saw that, stopped and chose B. saw that she has increased metanephrines...so basically she has pheochromo, and i'm guessing answer is E, correct?

4. 18 mth old boy with SCID needs blood transfusion for severe anemia, what's the best blood product to use?
a. irradiated packed rbcs
b. packed rbcs with adenine-saline aded
c. washed packed rbcs
d. whole blood -> chose this

23. 40 year old woman with breast cancer is brought to the physician because 1 week history of progressive loss of peripheral vision to left in both eyes. she is unable to count fingers or detect finger movements on the left. MRI of the brain is most likely to show metastic tumor to which location.
a. occipital lobe
b. optic chiasm
c. optic nerve
d. parietal lobe --> chose this
e. temporal lobe
- was thinking she had some form of hemineglect, so went with parietal lobe. looking at it now, i'm guessing it's temporal lobe, correct?

29. sperm with 1 and 10 carrying mutation, which phenomenon? is it germline mosaicism?

30. shows the h pylori strains and their respective codons to amino acids. i saw that it had an frame shift mutation, since it led to addition of a single amino acid causing non functional protein downstream, and one that was truncated. choices were:
a. crossing over - crossed this out
b. dna excision repair - crossed this out
c. slipped-strand mispairing
d. thymidine dimer formation - crossed this out
e. transposon insertion - went with this

7. ADHD questions. since adhd is more common among boys, girls and boys randomized into two treatment groups separately. which of the following types of treatment allocation is most likely being used in the study?
a. alternation
b. open
c. outcome-adapted
d. simple random assignment - chose this
e. stratification

12. patient with CML, most appropriate drug to use. chose hydroxyurea, guessing better answer was imatinib?

ill add the next batch tomorrow. thanks fellas.

 

[Smashingdude]

Following a stroke, a 68 year old man had a language problem. His speech is fluent but contains many grammatical errors, word substitutions, and neologisms. He is unable to repeat words after the examiner and is apparently unable to comprehend other verbal requests. Which area is damaged?

- I assumed that since he was able to speak properly, but couldn't comprehend what was being said to him, this was a problem in Wernike's area. However, it was incorrect.

Its angular gyurs, just above and posterior to Wernicke

31. 20 yo is taking recombinant EPO has polycythemia. Question asked which is the most likely cause?
- I recall Sattar or Goljan talking about how EPO causes early release of reticulocytes into the bone marrow. However, it was wrong. Other 3 choices were
b. increase rbc life span - wrong
c. proliferation of bone marrow stem cells - wrong
d. proliferation of erythroid precursors - guess this is right. i do recall somebody stating that EPO causes the stages of RBC production to be shortened in duration. is this the reason for it being correct? Yes this is correct

32. question about insecticide poisoning? question asked most appropriate immediate step is administration of what?
- i chose 2-pam, because i know you don't want timing to set in, because once it does, the ability to reform AchE is not possible. however the sentence before the question says she has copious oral secretions. is this the reason why the answer is atropine, instead? No, I checked Goljan. You give Pralidoxime only after stabalizing the patient. Seems kinda strange, but thats what his notes said

35. 72 year old woman comes in because of acute MI. angiography shows left dominant circulation (misread this), and 90% narrowing of the artery supplying the diaphragmatic surface and the AV node of the heart. what's the direction of the catheter being passed through the heart vessels?
a. left coronary, circumflex, anterior interventricular
b. left coronary, circumflex, posterior interventricular
c. left coronary, poster interventricular
d. right coronary, circumflex, anterior interventricular
e. right coronary, circumflex, poster interventricular
f. right coronary, poster interventricular, circumflex

50. CT scan of the adrenals. patient has elevated blood pressure. saw that, stopped and chose B. saw that she has increased metanephrines...so basically she has pheochromo, and i'm guessing answer is E, correct? I don't recall exactly, but yeah, seems like it

4. 18 mth old boy with SCID needs blood transfusion for severe anemia, what's the best blood product to use?
a. irradiated packed rbcs
b. packed rbcs with adenine-saline aded
c. washed packed rbcs
d. whole blood -> chose this
Irradiate packed rbc; remove the risk of CMV and other infections

23. 40 year old woman with breast cancer is brought to the physician because 1 week history of progressive loss of peripheral vision to left in both eyes. she is unable to count fingers or detect finger movements on the left. MRI of the brain is most likely to show metastic tumor to which location.
a. occipital lobe
b. optic chiasm
c. optic nerve
d. parietal lobe --> chose this
e. temporal lobe
- was thinking she had some form of hemineglect, so went with parietal lobe. looking at it now, i'm guessing it's temporal lobe, correct? No, its occipatal lobe. Its loss of peripheral vision in both eyes, and same defect. If it was temporal, it will be a quandriheminopsia (pie in sky or ground), but the question mentioned she doesnt have "Any visiion to the left side in both eyes", meaning the lesion is somewhere in occiptal

29. sperm with 1 and 10 carrying mutation, which phenomenon? is it germline mosaicism?Yes

30. shows the h pylori strains and their respective codons to amino acids. i saw that it had an frame shift mutation, since it led to addition of a single amino acid causing non functional protein downstream, and one that was truncated. choices were:
a. crossing over - crossed this out
b. dna excision repair - crossed this out
c. slipped-strand mispairing
d. thymidine dimer formation - crossed this out
e. transposon insertion - went with this
Actually, I got this right, but I don't remember what I chose. I was stuck as well. I think I chose c slipped-strand misparing....yes, I am 80% sure

7. ADHD questions. since adhd is more common among boys, girls and boys randomized into two treatment groups separately. which of the following types of treatment allocation is most likely being used in the study?
a. alternation
b. open
c. outcome-adapted
d. simple random assignment - chose this
e. stratification. They split the groups down, to assess the risk better

12. patient with CML, most appropriate drug to use. chose hydroxyurea, guessing better answer was imatinib? Yes

ill add the next batch tomorrow. thanks fellas.

I answered as many as I could.

Hope this helps!
Cheers

 

[Jonari]

hey thanks man...appreciate it. ill be posting up a few more tomorrow.

 

[CDI]

32 You'd routinely see in other countries. I treated a lot of farmers for OP poisoning (attempted suicide, most successful) - atropine is what actually saves them (in theory) - stops the leakiness. Pralidoxime is just to regenerate Ache/stop fasciculations, we didn't even give it to them all the time, but atropine is a must.

 

[Jonari]

32 You'd routinely see in other countries. I treated a lot of farmers for OP poisoning (attempted suicide, most successful) - atropine is what actually saves them (in theory) - stops the leakiness. Pralidoxime is just to regenerate Ache/stop fasciculations, we didn't even give it to them all the time, but atropine is a must.

touche. thanks for the input. looks like if i see this on my exam atropine > 2pam

 

[Corbac]

Pls help ,
The question with the ways of colon Ca metastasis to the liver and the Macro Pathology picture of the liver, what is the correct answer?

I cannot put all the details of the question and the answers because of copyright ...
Thanks a lot expect quick answer my real deal is soon .

 

[Jonari]

Pls help ,
The question with the ways of colon Ca metastasis to the liver and the Macro Pathology picture of the liver, what is the correct answer?

I cannot put all the details of the question and the answers because of copyright ...
Thanks a lot expect quick answer my real deal is soon .

i got that wrong, i wrote direct extension...im guessing the answer is hematogenous spread, but i didnt think colon cancer used hematogenous spread...all i knew that did were:

- hepatocellular carcinoma
- choriocarinoma
- follicular carcinoma of the thyroid
- renal cell carcinoma

 

[MedicineMike]

i got that wrong, i wrote direct extension...im guessing the answer is hematogenous spread, but i didnt think colon cancer used hematogenous spread...all i knew that did were:

- hepatocellular carcinoma
- choriocarinoma
- follicular carcinoma of the thyroid
- renal cell carcinoma

Yes, it was hematogenous spread

 

[MedicineMike]

Questions I need help with:

1. 27yo woman comes to doc bc of a 1-month history of shortness of breath w/ exertion and swelling of her legs. Her pulse is 90/min, respirations 22/min, and bp 120/80. Cardiac exam shows S3 and displaced apical impulse. Chest xray shows marked cardiomegaly and Kerley B lines. Echocardiography shows an ejection fraction of 29% (n=55%). Which of the following is the diagnosis?
A. Amyloidosis
B. Aortic insufficiency (wrong!)
C. Constrictive pericarditis
D. Dilated Cardiomyopathy
E. Hypertension

2. During normal skeletal muscle twitches, ATP concentration does not fall appreciably because of which of the following?
A. ATP is hydrolyzed only during relaxation
B. ATP is quickly regenerated from Creatine phosphate
C. Creatine phosphate is hydrolyzed by myosin
D. The initial ATP concentration is high

3. A man on hydrochlorothiazide gets light-headed and dizzy when he stands up to quickly. Which of following sets of changes (up or down arrows) best characterizes changes in the cardiovascular system as man goes from supine to standing?
Venous Return -- up or down
Carotid Sinus Baroreceptor activity -- up or down
Cerebral blood flow -- up or down

4. Man has a Pit tumor, the serum concentration of which hormone is most likely to be increased in this pt?
A. ADH (wrong)
B. Adrenocorticotropic
C. FSH
D. Growth
E. LH
F. Prolactin
G. TSH

5. Diphtheria vaccine confers protective immunity by inducing formation of antibodies against a preparation composed of which of the following?
A. Killed bacterial cells
B. Live attenuated bacterial cells
C. Purified bacterial peptidoglycan
D. Purified capsular polysaccharide
E. Purified inactivated toxin

6. Woman has DKA and give her insulin and she improves. Which enzyme most likely increased in this pt's hepatocytes because of this treatment?
A. Glucokinase
B. Glucose-6-phosphatase
C. Glycogen phosphorylase
D. Phosphoenolpyruvate carboxykinase (wrong)
E. Phosphorylase kinase

7. Vision screening on 4000 people. Cataracts found in 200. What is annual incidence of cataracts in this population?
.2%
.5%
2%
5% (wrong)
Unable to calculate due to insufficient data --- im pretty sure this is it and i'm ******ed

 

[addo]

Questions I need help with:

1. 27yo woman comes to doc bc of a 1-month history of shortness of breath w/ exertion and swelling of her legs. Her pulse is 90/min, respirations 22/min, and bp 120/80. Cardiac exam shows S3 and displaced apical impulse. Chest xray shows marked cardiomegaly and Kerley B lines. Echocardiography shows an ejection fraction of 29% (n=55%). Which of the following is the diagnosis?
A. Amyloidosis
B. Aortic insufficiency (wrong!)
C. Constrictive pericarditis
D. Dilated Cardiomyopathy
E. Hypertension

2. During normal skeletal muscle twitches, ATP concentration does not fall appreciably because of which of the following?
A. ATP is hydrolyzed only during relaxation
B. ATP is quickly regenerated from Creatine phosphate
C. Creatine phosphate is hydrolyzed by myosin
D. The initial ATP concentration is high

3. A man on hydrochlorothiazide gets light-headed and dizzy when he stands up to quickly. Which of following sets of changes (up or down arrows) best characterizes changes in the cardiovascular system as man goes from supine to standing?
Venous Return -- up or down
Carotid Sinus Baroreceptor activity -- up or down
Cerebral blood flow -- up or down

I got this wrong too. Pretty sure venous return goes down, carotid sinus activity increases and the part that im unsure about is cerebral blood flow... If its like a sequence of events I guess cerebral blood flow would go up

4. Man has a Pit tumor, the serum concentration of which hormone is most likely to be increased in this pt?
A. ADH (wrong)
B. Adrenocorticotropic
C. FSH
D. Growth
E. LH
F. Prolactin
G. TSH

Prolactinoma is the most common pituitary tumor

5. Diphtheria vaccine confers protective immunity by inducing formation of antibodies against a preparation composed of which of the following?
A. Killed bacterial cells
B. Live attenuated bacterial cells
C. Purified bacterial peptidoglycan
D. Purified capsular polysaccharide
E. Purified inactivated toxin

6. Woman has DKA and give her insulin and she improves. Which enzyme most likely increased in this pt's hepatocytes because of this treatment?
A. Glucokinase
B. Glucose-6-phosphatase
C. Glycogen phosphorylase
D. Phosphoenolpyruvate carboxykinase (wrong)
E. Phosphorylase kinase (wrong as well)
Got this wrong too. Im thinking its glucokinase

7. Vision screening on 4000 people. Cataracts found in 200. What is annual incidence of cataracts in this population?
.2%
.5%
2%
5% (wrong)
Unable to calculate due to insufficient data --- im pretty sure this is it and i'm ******ed
To calculate incidence would require to know the population, not just the number of people screened

In the question about the defect in renal ammoniagenesis, what is the source of ammonia production?

 

[MedicineMike]

In the question about the defect in renal ammoniagenesis, what is the source of ammonia production?

Glutamate was what I put...and thanks for the help

On the orthostatic question, I put CBF would go down when he stands up because isn't that the entire reason for him feeling dizzy/light-headed/syncope???

 

[addo]

Glutamate was what I put...and thanks for the help

On the orthostatic question, I put CBF would go down when he stands up because isn't that the entire reason for him feeling dizzy/light-headed/syncope???

Yea thats what I put too and that was my reasoning. Did you put decreased venous return, increased carotid sinus activity and decreased cerebral blood flow?

I just checked and the carotid sinus actually decreases firing, which increases efferent sympathetic activity... its on pg 264 of FA

 

[Jonari]

that orthostatic question was straight bull****...i couldnt understand if they were asking what was wrong with the patient and asking his arrows...or asking what is the normal physiologic response from going supine to standing up....got it wrong


what did you guys think about nbme 15, with respect to difficutly

 

[MedicineMike]

Yea thats what I put too and that was my reasoning. Did you put decreased venous return, increased carotid sinus activity and decreased cerebral blood flow?

I just checked and the carotid sinus actually decreases firing, which increases efferent sympathetic activity... its on pg 264 of FA

yeah I put increased carotid activity, decrease venous return, decrease CBF.

So basically yeah, you are right. They wanted the EXACT instance before the carotid sinus increased sympathetic activity. I hate these questions...I always have a hard time putting myself in that exact point in time that they want me to be at

 

[MedicineMike]

that orthostatic question was straight bull****...i couldnt understand if they were asking what was wrong with the patient and asking his arrows...or asking what is the normal physiologic response from going supine to standing up....got it wrong


what did you guys think about nbme 15, with respect to difficutly

Thought it is was medium, but probably exactly what the exam will be like.. Long stems, a lot of wtf questions that take a lot of time, and a lot of super easy ones that I over-think and get them wrong. My biggest thing holding me back from stepping in the big leagues is myself. I make idiotic mistakes all the time.

 

[Jonari]

6. Woman has DKA and give her insulin and she improves. Which enzyme most likely increased in this pt's hepatocytes because of this treatment?
A. Glucokinase
B. Glucose-6-phosphatase
C. Glycogen phosphorylase
D. Phosphoenolpyruvate carboxykinase (wrong)
E. Phosphorylase kinase (wrong as well)


I'm fairly certain the answer for this is A. All the other enzymes in the list are associated with glycogenolysis and gluconeogenesis....

 

[Jonari]

Thought it is was medium, but probably exactly what the exam will be like.. Long stems, a lot of wtf questions that take a lot of time, and a lot of super easy ones that I over-think and get them wrong. My biggest thing holding me back from stepping in the big leagues is myself. I make idiotic mistakes all the time.

Was hoping you were going to say it was tough. Got 44 wrong on this, 2-3 of which I shouldn't have gotten wrong. I'm praying the real deal won't be as difficult.

 

[Corbac]

Thank you guys

 

[Corbac]

6. Woman has DKA and give her insulin and she improves. Which enzyme most likely increased in this pt's hepatocytes because of this treatment?
A. Glucokinase
B. Glucose-6-phosphatase
C. Glycogen phosphorylase
D. Phosphoenolpyruvate carboxykinase (wrong)
E. Phosphorylase kinase (wrong as well)


I'm fairly certain the answer for this is A. All the other enzymes in the list are associated with glycogenolysis and gluconeogenesis....

I got it wrong too .
It is A. Glucokinase for sure .

 

[Corbac]

that orthostatic question was straight bull****...i couldnt understand if they were asking what was wrong with the patient and asking his arrows...or asking what is the normal physiologic response from going supine to standing up....got it wrong


what did you guys think about nbme 15, with respect to difficutly

Very twisted questions

 

[Corbac]

Yes, it was hematogenous spread

Interesting enough , Pathoma talks about hematogenous spread of the sarcomas and the 4 carcinomas with the hepatocellular carcinoma ( invading the hepatic vein ) and the question asked about the portal vein which makes more sense ...

 

[Corbac]

Pls help with the question of the experiment in which the CD 44 splice variants correlates with the aggressive Hodgkin 's lymphoma
What was the most effective method of screening the archives for the variant proteins .

I have a hard time with the concept here ...

I am not going to put ALL the answers due to copyright .

Thanks .

 

[Corbac]

Endoderm

I had also a hard time with this one .
Thank you guys .

 

[addo]

Pls help with the question of the experiment in which the CD 44 splice variants correlates with the aggressive Hodgkin 's lymphoma
What was the most effective method of screening the archives for the variant proteins .

I have a hard time with the concept here ...

I am not going to put ALL the answers due to copyright .

Thanks .

The answer for that one was immunohistochemistry. It was asking how you would identify a protein variant, which is saying it wont differ from the original protein by much so you cant use column chromatography and you cant rely on density centrifugation or whatever the answer choice said.

 

[addo]

that orthostatic question was straight bull****...i couldnt understand if they were asking what was wrong with the patient and asking his arrows...or asking what is the normal physiologic response from going supine to standing up....got it wrong


what did you guys think about nbme 15, with respect to difficutly

Oddly enough, the behavioral questions, which i have been doing really well on, are what got me on this one. Got 17 wrong for a 254. Baseline was 230 with nbme 6 about 2 months ago. Now Im averaging mid 250s for 2 nbmes and 2 uworld practice tests. I got one more nbme that i have already bought (12) and im debating whether to buy 7 and 11. If I wasnt so broke I would buy them both, but I can only get one. What do you all think 7 or 11?

 

[Corbac]

Thought this test was pretty tough..

Can anybody help me with the answers to:
- renal tubular acidosis patient w. defect in renal amniogenesis...What is their source of ammonia?

- Pt. with H.pylori...what would decrease recurrence? (smoking?)

- Floppy baby w/ defect in inhibitory neuron (glutamate? glycine?)

- ADHD behavioral program...more common in boys...boys and girls separated randomly in 2 groups...type of treatment allocation? (stratification/alteration/open/outcome adapted/stratification?)

- why deoxygenated blood can carry more CO2 than oxygenated blood

- sexually active 26 y/o w/ lump on rectal area...severe pain, no bleeding, inconsistently uses condoms (anal carcinoma, anal fissure, external hemorhoid, HPV, skin tag)

Thanks!

- sexually active 26 y/o w/ lump on rectal area...severe pain, no bleeding, inconsistently uses condoms (anal carcinoma, anal fissure, external hemorrhoid, HPV, skin tag)

This one I missed too .
The correct one is HPV which causes the SCC of the anus ( ectoderm Ca , this is the reason for pain ) .
The general rule in this type of question where you see also pictures should be HPV .
The picture was not the best one and confusing ... .

-why deoxygenated blood can carry more CO2 than oxygenated blood.
This is Halden effect . Correct answer is buffering better .. .

 

[Corbac]

The answer for that one was immunohistochemistry. It was asking how you would identify a protein variant, which is saying it wont differ from the original protein by much so you cant use column chromatography and you cant rely on density centrifugation or whatever the answer choice said.

Thanks man .
Got it .

 

[Corbac]

Oddly enough, the behavioral questions, which i have been doing really well on, are what got me on this one. Got 17 wrong for a 254. Baseline was 230 with nbme 6 about 2 months ago. Now Im averaging mid 250s for 2 nbmes and 2 uworld practice tests. I got one more nbme that i have already bought (12) and im debating whether to buy 7 and 11. If I wasnt so broke I would buy them both, but I can only get one. What do you all think 7 or 11?

.

Try NBME 7 is more relevant than 11 .
I did 7 and found difficult ..220

 

[addo]

- sexually active 26 y/o w/ lump on rectal area...severe pain, no bleeding, inconsistently uses condoms (anal carcinoma, anal fissure, external hemorrhoid, HPV, skin tag)

This one I missed too .
The correct one is HPV which causes the SCC of the anus ( ectoderm Ca , this is the reason for pain ) .
The general rule in this type of question where you see also pictures should be HPV .
The picture was not the best one and confusing ... .

-why deoxygenated blood can carry more CO2 than oxygenated blood.
This is Halden effect . Correct answer is buffering better .. .

The answer for question with the picture of the anus was an external hemorrhoid.

 

[addo]

.

Try NBME 7 is more relevant than 11 .
I did 7 and found difficult ..220

thanks, thats what I was thinking too.

 

[Corbac]

The answer for question with the picture of the anus was an external hemorrhoid.

Thanks Man

I was looking into the Hx more than the picture .

 

[soccerboy2288]

Hi guys, was wondering if I could get some help on some of the questions. A brief EXPLANATION would be great too if you have one.

Before I post though, I briefly read some of the above posts and thought I'd contribute:
- I got the Down Syndrome with ALL wrong too. I put MEGALOBLASTOSIS because of pathoma. But note that Megaloblastosis DOES NOT refer to Megakaryoblastic Leukemia, it refers to large RBC's (MCV>100). So I guess pathoma isn't wrong in this case.

- saw someone post that the anal lesion with a picture was SCC of the anus, but its actually external hemorrhoids (painful and doesn't bleed). Maybe someone already corrected this.

My questions:

Lymphocyte neoplasm DOES NOT express: CD4, CD8, surface igM, surface IgG, cytoplasmic IgM and mu-heavy chains, cytoplasmic IgG, and gamma-heavy chains. It DOES express class I MHC and show rearrangement of the T-lymphocyte receptor beta-chain gene D and J segments. Which is the normal counterpart?
a. Activated cytolytic effector T lymphocytes in circulation
b. Mature IgM-secreting B lympchotes in LN
c. Mature Immunoglovulin secreting plasma cells in LN
d. Pre-B lymphocyte progenitor of mature B lymphobytes in the BM
e. T-lymphocyte thyocytes localized to the thymic cortex

Kid presents with congestive heart failure due to a VSD. After fixing the VSD, what changes will be seen in the following:
- Left Ventricular P
- Right Ventricular P
- Left Atrial P
I though the Right ventricular P would obviously go down since the Left -> Right shunt will be closed off. What happens to LV and LA pressure and Why?? This one drove me nuts! (I put increased LA pressure because the Right ventricle wont be as overloaded from the shunt, and will be able to pump blood out more effectively, but that was wrong)

4. Woman has history of altered consciousness. She stops talking in mid-sentence, turns her head to the right, and extends and stiffens her right upper extremity. She has a blank look and does not respond to any questions. She then has some repetitive lip smacking and picking movement of the hands. Episodes lasts 30secs. She slowly returns to he normal state during the next 4-5min. What type of seizure is it?
- Absence
- Complex partial
- Generalized tonic clonic
- Simple partial motor
- Simple partial sensory
Put Tonic clonic just cause I saw the stiffness, followed by a repetitive movement. Is this wrong because its not the entire body/extremities? Is the answer Complex partial? Didn't know it would switch from stiffness to clonus like that.

67 year old man comes to the physician because of a 2 month history of pain in his feet. It is more severe at night and is relieved by taking a hot bath. He has DM2. Strength is normal and symmetric in the distal and proximal upper and lower extremities. Achilles deep tendon reflexes are decreased and quadricept deep tendon reflexes are normal. Sensation to pinprick and vibration is decreased from just above the ankles distally. This patients pain is most likely described as?
- Aching, Burning, Colicky, Cramping, Sharp, Squeezing
Put sharp thinking it was neuropathy induced pain, but I'm guessing its Cramping due to peripheral vascular disease?? Does DM neuropathy not present with sharp pain (Probably made that up during the exam haha)?

Thanks in advance guys! Again, explanations would be greatly appreciated!

 

[MedicineMike]

4. Woman has history of altered consciousness. She stops talking in mid-sentence, turns her head to the right, and extends and stiffens her right upper extremity. She has a blank look and does not respond to any questions. She then has some repetitive lip smacking and picking movement of the hands. Episodes lasts 30secs. She slowly returns to he normal state during the next 4-5min. What type of seizure is it?
- Absence
- Complex partial
- Generalized tonic clonic
- Simple partial motor
- Simple partial sensory
Put Tonic clonic just cause I saw the stiffness, followed by a repetitive movement. Is this wrong because its not the entire body/extremities? Is the answer Complex partial? Didn't know it would switch from stiffness to clonus like that.

Complex Partial is the answer. The key here is NO Loss of consciousness and the automatisms after the seizure

67 year old man comes to the physician because of a 2 month history of pain in his feet. It is more severe at night and is relieved by taking a hot bath. He has DM2. Strength is normal and symmetric in the distal and proximal upper and lower extremities. Achilles deep tendon reflexes are decreased and quadricept deep tendon reflexes are normal. Sensation to pinprick and vibration is decreased from just above the ankles distally. This patients pain is most likely described as?
- Aching, Burning, Colicky, Cramping, Sharp, Squeezing
Put sharp thinking it was neuropathy induced pain, but I'm guessing its Cramping due to peripheral vascular disease?? Does DM neuropathy not present with sharp pain (Probably made that up during the exam haha)?

Burning - I'm pretty sure burning is the sensation with diabetic neuropathy. I put this and got it right

I forget the answers to the other 2. So someone else can chime in

 

[Corbac]

Pls help :
1.The question of the 25 yrs old man participating in the muscle function study ..3 columns were put with : epp-Amplitude , mepp- Amplitude and response in mV to Ach .
Based on the normal values the question asked about the muscle Bx specimen in Acute botulism
I answered A which was wrong .

I am not good in experiment questions ... .

6.During the experiment of muscle contraction intracellular Ca is decreased after a substance is adm .The question asks WHY contraction is inhibited in this case .
I answered E which was wrong .
Somebody with a better idea ?

Much appreciated .

 

[ZzzZzzZzzZzzZzz]

6. Woman has DKA and give her insulin and she improves. Which enzyme most likely increased in this pt's hepatocytes because of this treatment?
A. Glucokinase
B. Glucose-6-phosphatase
C. Glycogen phosphorylase
D. Phosphoenolpyruvate carboxykinase (wrong)
E. Phosphorylase kinase (wrong as well)


I'm fairly certain the answer for this is A. All the other enzymes in the list are associated with glycogenolysis and gluconeogenesis....

I got it wrong too .
It is A. Glucokinase for sure .

I got this question wrong, but I thought that the liver has GLUT 2 receptors and is insulin independent. As a result, glucokinase which is primarily located in the liver wouldn't see an an increase because of the GLUT 2 receptor. Am I missing something?

 

[Jonari]

I got this question wrong, but I thought that the liver has GLUT 2 receptors and is insulin independent. As a result, glucokinase which is primarily located in the liver wouldn't see an an increase because of the GLUT 2 receptor. Am I missing something?

I think you guys are just over thinking this. DKA, too much glucose in the blood correct, that isn't getting taken up. Glucokinase is inducible, hence why it has a high Vmax, by insulin. This was the logic that I used, and in addition going back to my previous argument, all the other enzymes listed would only make the situation worse since they would lead to an increase glucose levels in the blood.

 

[Jonari]

Pls help :
1.The question of the 25 yrs old man participating in the muscle function study ..3 columns were put with : epp-Amplitude , mepp- Amplitude and response in mV to Ach .
Based on the normal values the question asked about the muscle Bx specimen in Acute botulism
I answered A which was wrong .

I am not good in experiment questions ... .

I didn't think this question was too hard. If you could post it up again, I'll tell you what the answer is. I know that the Ach levels on the far right hand corner would remain 1, the answer was either A or B...

6.During the experiment of muscle contraction intracellular Ca is decreased after a substance is adm .The question asks WHY contraction is inhibited in this case .
I answered E which was wrong .
Somebody with a better idea ?

Much appreciated .

something about myosin and troponin C interaction.

 

[Corbac]

yeah I put increased carotid activity, decrease venous return, decrease CBF.

So basically yeah, you are right. They wanted the EXACT instance before the carotid sinus increased sympathetic activity. I hate these questions...I always have a hard time putting myself in that exact point in time that they want me to be at

I got this one wrong too and answered exactly like you .
what FA edition you found the correct explanation .

Thanks a lot .. very annoying question .

 

[Corbac]

I didn't think this question was too hard. If you could post it up again, I'll tell you what the answer is. I know that the Ach levels on the far right hand corner would remain 1, the answer was either A or B...



something about myosin and troponin C interaction.

Thanks a lot .

The 25 years old with the Muscle study the correct one is E according to your reasoning .
I put A and was wrong .

The other one I'll review the trop C but I do not know what substance they added ..

Any other thoughts ?
Appreciated .

 

[Jonari]

Thanks a lot .

The 25 years old with the Muscle study the correct one is E according to your reasoning .
I put A and was wrong .

The other one I'll review the trop C but I do not know what substance they added ..

Any other thoughts ?
Appreciated .

look at that muscle study question...because i know for a fact there was another option that had the value of 1 as the answer choice for Ach on the far right hand side...can you just post up a link to the question?