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?

---

Members don't see this ad.

 

[dggopal]

I'm trying to look up the answers to save you guys time and you can either agree/disagree with what I find. If I have no effing clue, then I'll list the answer choices. Aaaaand go!

--Guy who lives with cats and avoids people... but apparently that's not avoidant. What am I missing?

Even I got this one wrong
Just looked at First Aid and I don't remember the choices given but looks like Schizoid personality disorder.

description in FA is "voluntary social isolation with limited emotional expression, content with social isolation"

 

[Jonari]

Okay, let's see what I can contribute... Just read the whole thread (that was exhausting but good work guys). One quick note:

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

Venous return down, cerebral blood flow down, and I want to say carotid sinus baroreceptor activity down (I got it right so I cant see it)... Keep in mind the baroreceptors send out inhibitory signals so it's the opposite of what you'd expect. They sense a drop in BP, and then they decrease their inhibitory signals in order to allow your sympathetic nervous system to increase your heart rate. It's kind of like that tricky thyroid hormone question... even though the end result is increased sympathetic activity, the direct effect (whenever it says "direct" I've learned to anticipate a trick) is via decreased inhibition from the baroreceptors. Sorry that that's complicated... let me know if I got it twisted.


Now I'm gonna go over my wrong answers, so stay tuned for some of my questions.

that question was straight ******ed in the wording. i wasn't sure if it was asking what would be the arrows for this patient, specifically, or asking what's the normal physiologic response. i got it wrong, sorry couldn't help.

I'm trying to look up the answers to save you guys time and you can either agree/disagree with what I find. If I have no effing clue, then I'll list the answer choices. Aaaaand go!

--Half hour after uncomplicated vaginal delivery, mother is still bleeding/hypotensive. What treatment would be "helpful"? (Thought that was a funny word selection)
A) androgen
B) estrogen
C) progesterone
D) Prolactin
E) Oxytocin

this one is oxytocin. contraction of the uterus would help to stop the bleeding. it probably doesn't make sense, & i can't really think of a good analogy to use to help explain it either. basically, she's using blood, giving her oxy would contract the uterus and stop the vessels from continuing to bleed.

--The 4 day old male with respiratory depression, periauricular skin tags, micrognathia, mandibular cleft, etc.... Is that supposed to be Treacher Collins?

don't recall this sorry

--3 year old girl with Mycobacterium avium infection with normal immunoglobulins... It seems to be IL-12 receptor deficiency but that's not an answer choice. The next best thing is IFN-gamma receptor which may have the same effect? Either way it looks like a macrophage problem.

is this the ? that had the option of not producing granulomas, correct? i believe the option was not producing any IFN-gamma.

--Back to the H. pylori (you guys already mentioned it), but the pain improves with food. That makes me think duodenal ulcer, and I always thought the pain was relieved by food because it gets a bunch of bicarb when you eat to neutralize the acid. Does it not work like this? Then again, H. pylori alkalinizes the stomach so who knows. I think the answer was smoking cessation.

post up the question, don't recall this.

--Guy who lives with cats and avoids people... but apparently that's not avoidant. What am I missing?

avoids =/= avoidant. this was schizoid if i'm not mistaken. ill try to clear this up with you with super heroes and villians...

Magneto from X-men, i think he's got an avoidant personality disorder...
- extremely sensitivity towards rejection
- excessive shyness, high anxiety levels - dude was always afraid of being a mutant
- social isolation, but an intense, internal desire for affection and acceptance
- wants the world to change, to be nice, more accepting - lol c'mon dude wants all non-mutants to accept mutants, in the film, right?

Bruce Wayne/Batman is your typical Schizoid personality disorder
- lifelong pattern of social withdrawal, and they like that way - c'mon im sure you saw all of Nolan's films...
- seen by others as eccentric, isolated, withdrawn
- restriced emotional expression

--Endocarditis after root canal... Is it strep mitis? Goes to show if it's not in first aid I haven't learned it
K that's all for now. Thanks everybody, keep up the good work!

yup!

A person going for surgery under gen anesthesia. He is out after only 3-5 breaths of inhalational anesthetic. Which of the following properties of the anesthetic is the most likely explanation for the rapid onset of action?

was trying top decide between Low blood solubility and low MAC.

Correct me if I am wrong but low blood solubility= high lipid solubility= low MAC right?

Am I missing something... I read FA saying low blood sol = fast induction but I'm just wondering if low MAC alludes to the same thing

i got this wrong as well...i thought i knew the concept, but apparently dont

high lipid drug = high potency = high blood:gas ratio = lower MAC value

 

[withrye]

high lipid drug = high potency = high blood:gas ratio = lower MAC value

Onset, solubility, and blood gas partitioning go together as concepts. Low solubility means very little is needed to saturate the blood. This is the same as a low blood gas partition. The faster you saturate the blood, the faster you begin to have an effect.

Potency and MAC go together. They are related to the concentration of gas that goes through the tube, and how much anesthesia that concentration will cause, irrespective of how long it takes to have that effect.

You can't predict MAC/potency based on time-of-onset/blood gas partition coefficient, and vice versa. In the question above, a patient who got some under after only a few breaths is likely breathing something with a really low solubility (fast onset). Either that, or the concentration is jacked way up (which says nothing about the MAC).

 

[Jonari]

Onset, solubility, and blood gas partitioning go together as concepts. Low solubility means very little is needed to saturate the blood. This is the same as a low blood gas partition. The faster you saturate the blood, the faster you begin to have an effect.

Potency and MAC go together. They are related to the concentration of gas that goes through the tube, and how much anesthesia that concentration will cause, irrespective of how long it takes to have that effect.

You can't predict MAC/potency based on time-of-onset/blood gas partition coefficient, and vice versa. In the question above, a patient who got some under after only a few breaths is likely breathing something with a really low solubility (fast onset). Either that, or the concentration is jacked way up (which says nothing about the MAC).

crap...thanks for this

 

[dbeast]

Onset, solubility, and blood gas partitioning go together as concepts. Low solubility means very little is needed to saturate the blood. This is the same as a low blood gas partition. The faster you saturate the blood, the faster you begin to have an effect.

Potency and MAC go together. They are related to the concentration of gas that goes through the tube, and how much anesthesia that concentration will cause, irrespective of how long it takes to have that effect.

You can't predict MAC/potency based on time-of-onset/blood gas partition coefficient, and vice versa. In the question above, a patient who got some under after only a few breaths is likely breathing something with a really low solubility (fast onset). Either that, or the concentration is jacked way up (which says nothing about the MAC).

This is a really good explanation.

 

[live]

The "football player who is the star wrestler also and asks about his breasts after his dad leaves the room question" was confusing to me because I couldn't figure out if he was on steroids but didn't want his dad to know OR if NBME just wanted us to know that gyncomastia is normal at 18. The latter was the answer on a previous NBME. What did yall think?

 

[Jonari]

Strong work with the X-men, that totally helps.

The kid with the facial abnormalities was asking which branchial arch was altered in development. Does that ring a bell? Look up Treacher Collins Syndrome (1st arch).

oh right, got this wrong, still haven't found the answer yet.

Here's the H. pylor

So I was thinking duodenal ulcer (pain relieved w/ food) which is for our purposes never cancerous, and rather usually acid related. That's why I picked caffeine over smoking, but I think somebody said earlier in the thread that smoking was the answer. What do you guys think?

i got this question right - only chose B to help with the life style change/modification needed. patient does have duodenal ulcer like you suggested, and eating foods helps - so why tell them to stop eating?

5 year stung by bee
No idea on this one. It's one of those "at this time following an injury, what is happening?" and I always seem to get these messed up. They do it with the heart a lot too. If anybody has a good way to keep it straight, I'd appreciate it big time.

gets stung, mast cells release histamine, correct? this question is a tad tricky, especially if you read it too fast. i was going to quickly write E, but chose C. histamine causes the pericytes of the endothelial cells to contract at the postcapillary venules, and this causes fluid to go into the tissues leading to edema, which the question is asking about.

This one sounds like a genetic syndrome, but for whatever reason I couldn't put it together. Anybody know what it is?

this was zellweger's syndrome - it's a problem in peroxisomes. the hint in the clue was: "very long chain fatty acids", if you open your FA up, and look under the "peroxisomes" which is in the biochemistry portion - it tells you it's responsible for degrading VLCFA.

Football player with gynecomastia. Was he on steroids? I put to reassure him (ya know, before asking if he was on steroids)

that's correct, did you get this wrong...because that's what i put, and didn't get it wrong

edit: sorry, read your post too fast, you do ask him if he's on steroids

Last but not least... Metal worker who passes out and smells like burnt almonds (cyanide poising). Seems straightforward, right? Buuut they specifically said he's non-cyanotic and that's how cyanide originally got it's effing name. Come on, NBME. Is it because it takes a while for cyanosis to develop?

Thanks peeps!

yeah no idea...damn didnt know burned almonds = cyanide poisoning..it was asking the treatment right...my ******* chose hyperbaric, but for CN poisoning you want to induce meth-Hb formation, since CN has greater affinity for meth-HB...iirc, amyl nitrite was an answer choice, correct....so that would be it

 

[Jonari]

strange...i know i made a few posts after this...

 

[ZzzZzzZzzZzzZzz]

--Back to the H. pylori (you guys already mentioned it), but the pain improves with food. That makes me think duodenal ulcer, and I always thought the pain was relieved by food because it gets a bunch of bicarb when you eat to neutralize the acid. Does it not work like this? Then again, H. pylori alkalinizes the stomach so who knows. I think the answer was smoking cessation.

I'm thinking if there is any answer choice to stop smoking, its more likely correct if you play odds. The only exception I can think of is that smoking is protective against ulcerative colitis. I too got this questions wrong by picking the stop eating fatty foods.

The "football player who is the star wrestler also and asks about his breasts after his dad leaves the room question" was confusing to me because I couldn't figure out if he was on steroids but didn't want his dad to know OR if NBME just wanted us to know that gyncomastia is normal at 18. The latter was the answer on a previous NBME. What did yall think?

Was there a choice about steroids or drugs, I think that's the right one

 

[addo]

The "football player who is the star wrestler also and asks about his breasts after his dad leaves the room question" was confusing to me because I couldn't figure out if he was on steroids but didn't want his dad to know OR if NBME just wanted us to know that gyncomastia is normal at 18. The latter was the answer on a previous NBME. What did yall think?

Was wondering about this as well... the question said he was tanner stage 5. Maybe gynecomastia isnt normal at this stage? does anyone have any idea if gynecomastia is specific or normal to a specific tanner stage?

 

[addo]

--The 4 day old male with respiratory depression, periauricular skin tags, micrognathia, mandibular cleft, etc.... Is that supposed to be Treacher Collins?
I think so... answer was first pharyngeal arch.

--Back to the H. pylori (you guys already mentioned it), but the pain improves with food. That makes me think duodenal ulcer, and I always thought the pain was relieved by food because it gets a bunch of bicarb when you eat to neutralize the acid. Does it not work like this? Then again, H. pylori alkalinizes the stomach so who knows. I think the answer was smoking cessation.
I got this wrong, but i believe people have already said smoking cessation was the right answer

-

 

[addo]

By the way, this is avoidant

 

[Jonari]

By the way, this is avoidant

[IMGpg[/IMG]

really? i thought it was avoidant mostly because of him constantly getting into trouble with the law and what not...

 

[chettybangbang]

Hey just have two questions:
One was a man coming into the ER with decreased O2 content in arterial and mixed venous O2 content. And it asked what is likely explanation to these findings.

I think the answer was High Altitude? Not sure about how to go about answering that one.

Also another one was ER with a S4 low BP and pulsatile periumbilical mass. Anyone remember the answers to these off the top of their head?

 

[Jonari]

Hey just have two questions:
One was a man coming into the ER with decreased O2 content in arterial and mixed venous O2 content. And it asked what is likely explanation to these findings.

I think the answer was High Altitude? Not sure about how to go about answering that one.

Also another one was ER with a S4 low BP and pulsatile periumbilical mass. Anyone remember the answers to these off the top of their head?

got the first question wrong...hoping somebody can explain it...

dont recall the 2nd question...can you post a bit more info it

 

[dbeast]

Hey just have two questions:
One was a man coming into the ER with decreased O2 content in arterial and mixed venous O2 content. And it asked what is likely explanation to these findings.

I think the answer was High Altitude? Not sure about how to go about answering that one.

Also another one was ER with a S4 low BP and pulsatile periumbilical mass. Anyone remember the answers to these off the top of their head?

I think it's anemia although I also got it wrong. Think about the O2 content- it's referring to the total amount of O2 in the blood, which is low due to decreased O2 carrying capacity aka anemia. This makes him hyperventilate which decreases CO2.

The pulsitile mass was some sort of aneurysm I believe.

 

[TrueAntagonist]

Hey just have two questions:
One was a man coming into the ER with decreased O2 content in arterial and mixed venous O2 content. And it asked what is likely explanation to these findings.

I think the answer was High Altitude? Not sure about how to go about answering that one.

Also another one was ER with a S4 low BP and pulsatile periumbilical mass. Anyone remember the answers to these off the top of their head?

took this a few weeks ago so don't remember the question. Can you give more of the vignette?
High altitude would definitely cause a decreased O2 content. Did they say anything about the percent saturation of Hb?

For the second dude, pulsatile mass in abdomen + low BP makes me think ruptured abdominal aneursym. Is that one of the answer choices?

 

[Corbac]

-

.
Yes is the same family of syndromes however Pierre Robin syndrome fits better the description .
I look into wiki and I found Pierre Robin .

 

[Corbac]

I think it's anemia although I also got it wrong. Think about the O2 content- it's referring to the total amount of O2 in the blood, which is low due to decreased O2 carrying capacity aka anemia. This makes him hyperventilate which decreases CO2.

The pulsitile mass was some sort of aneurysm I believe.

The one with low o2 sat I got wrong thinking it was high altitude .
The correct answer was anemia as it was already said .

 

[Corbac]

Onset, solubility, and blood gas partitioning go together as concepts. Low solubility means very little is needed to saturate the blood. This is the same as a low blood gas partition. The faster you saturate the blood, the faster you begin to have an effect.

Potency and MAC go together. They are related to the concentration of gas that goes through the tube, and how much anesthesia that concentration will cause, irrespective of how long it takes to have that effect.

You can't predict MAC/potency based on time-of-onset/blood gas partition coefficient, and vice versa. In the question above, a patient who got some under after only a few breaths is likely breathing something with a really low solubility (fast onset). Either that, or the concentration is jacked way up (which says nothing about the MAC).

The explanation is very good. Thanks

 

[Corbac]

The young woman who became infected with HIV and her HIV became resistant to Ritonavir/Lopinavir .

I missed this question because I did not know what to chose from the 2 answers which can be possibly correct:
One is late protein synthesis and the other one is Protein processing .
I spent a lot of time and still not 100 % sure .
My bet is Protein processing .

FA give some explanation on page 216 /2012 edition however is not specific .

Can someone come with an idea ?
Thanks a lot .

 

[addo]

The young woman who became infected with HIV and her HIV became resistant to Ritonavir/Lopinavir .

I missed this question because I did not know what to chose from the 2 answers which can be possibly correct:
One is late protein synthesis and the other one is Protein processing .
I spent a lot of time and still not 100 % sure .
My bet is Protein processing .

FA give some explanation on page 216 /2012 edition however is not specific .

Can someone come with an idea ?
Thanks a lot .

Those are protease inhibitors, so the answer would be protein processing.

 

[MrWheat]

Does anyone remember how to do the biostats question where it says 15% to have something something, I cant even remember the exact numbers. The choices were something like 20% Type I error, 15% Type II error, etc etc

Thanks!

 

[addo]

Does anyone remember how to do the biostats question where it says 15% to have something something, I cant even remember the exact numbers. The choices were something like 20% Type I error, 15% Type II error, etc etc

Thanks!

I dont remember very well, but i think it asked what the chance of making an error was when the experiment rejected the null hypothesis. The error would be to reject the null hypothesis when it is in fact the reality. This would be a type 1 error and the chances of making it depends on the P value which is usually set at an alpha threshold of .05 or 5% to be statistically significant.

 

[Corbac]

Those are protease inhibitors, so the answer would be protein processing.

.
Thanks a lot .

 

[MrWheat]

I dont remember very well, but i think it asked what the chance of making an error was when the experiment rejected the null hypothesis. The error would be to reject the null hypothesis when it is in fact the reality. This would be a type 1 error and the chances of making it depends on the P value which is usually set at an alpha threshold of .05 or 5% to be statistically significant.

Oh ok thanks. I got tripped up on all those %'s ..

 

[USCTrojan11]

Surprised no1 asked this yet

17 YO boy 4 month hx of low back pain, night sweats, 9 lb weight loss. No other PMH, immigrated from india. Appears chronically ill and cachectic. 5'3 100 lbs BMI 18 - severe tenderness over L1 spinous process posteriorly, passive movement of hip limited due to pain.

Herniated disk impinging on root (wrong)
Osteoblastoma of thoracic spin
Osetoporotic fracture
Spinal stenosis
Syringomyelia of cervical spine
Tuberculous abscess of spine

 

[Jonari]

Surprised no1 asked this yet

17 YO boy 4 month hx of low back pain, night sweats, 9 lb weight loss. No other PMH, immigrated from india. Appears chronically ill and cachectic. 5'3 100 lbs BMI 18 - severe tenderness over L1 spinous process posteriorly, passive movement of hip limited due to pain.

Herniated disk impinging on root (wrong)
Tuberculous abscess of spine

i edited your post...because i hate writing explanations to get them deleted by mods...


anyways, the bolded parts are classic s/s for TB. in addition the ? tells you that the patient feels pain in the level of the lumbar spinal cord. TB has the capability to "metastasize" - it can go to the meninges - specifically at the level of the arachnoid granulations and cause communicating/non-obstructive hydrocephalus.

in addition it can go to the lumbar vertebrae, and cause what is known as "Pott's vertebrae", which is the answer - "TB abscess of the spine".

 

[suji0]

does anyone know the answer to the one with defective ammoniogenesis and what would be the source of ammonia in the girl? i feel like this must be an extremely simply answer/concept that i overlooked

 

[chettybangbang]

Glutamine IIRC

 

[USCTrojan11]

i edited your post...because i hate writing explanations to get them deleted by mods...


anyways, the bolded parts are classic s/s for TB. in addition the ? tells you that the patient feels pain in the level of the lumbar spinal cord. TB has the capability to "metastasize" - it can go to the meninges - specifically at the level of the arachnoid granulations and cause communicating/non-obstructive hydrocephalus.

in addition it can go to the lumbar vertebrae, and cause what is known as "Pott's vertebrae", which is the answer - "TB abscess of the spine".

Thank you!

Also in the diagram of the optic chiasm with a man who had "left sided vision loss" and couldn't see to the left out of each eye (wording was terrible) is it just a homonymous hemianopsia with a lesion in the contralateral optic tract?

 

[Jonari]

Thank you!

Also in the diagram of the optic chiasm with a man who had "left sided vision loss" and couldn't see to the left out of each eye (wording was terrible) is it just a homonymous hemianopsia with a lesion in the contralateral optic tract?

ohh yeah, my potato self chose the opposite tract...im guessing that's what you did? i forgot the orientation and had a brain fart and chose the opposite answer...

 

[Jonari]

does anyone know the answer to the one with defective ammoniogenesis and what would be the source of ammonia in the girl? i feel like this must be an extremely simply answer/concept that i overlooked

a lot of people had trouble with this...i know you know this mang...

what're the two sources of nitrogen for the urea cycle

1. aspartate
2. ammonia

now what're the two sources for ammonia
- glutamine
- glutamate

 

[Akr]

Just took this today and got some Qs

1. A 52 yo man comes in w/ sudden onset blindness of left eye.
F. no constriction b/c the retinal ganglion cells in left eye have been destroyed

2. A 36 yo man who's heterozygous for LDL-receptor deficiency has total serum cholesterol concentration of 330.
C. LDL receptor

3. A 47yo man presents with MI. On admission, pulseOx on 30% O2 shows O2 saturation greater than 95%. T
F. increased pulmonary capillary pressure (is it this one b/c of CHF?... just thought about it while going through incorrrects :x) I'm pretty sure I picked this one thinking about CHF, because of the MI and then the crackles and murmur.

4. Long stem but asks that the fetus is at increased risk for which of the following because of mom's cocaine use?

E. prematurity (post above mentioned this but why? FA lists abnormal fetal development and fetal addiction; placental abruption). I think due to vasoconstriction, and thus decreased blood overall to the fetus

That's it folks

Added some stuff in bold

 

[CrouchingLiger]

Just took it today and figured i could help out some. People already answered these but I think I can fill in a few of the details in explanations. I'll post my own questions sooner or later if i have any that weren't already answered.

4. Long stem but asks that the fetus is at increased risk for which of the following because of mom's cocaine use?

A. down syndrome
B. heart defect (picked this one)
C. hypothyrodism
D. neural tube defect
E. prematurity (post above mentioned this but why? FA lists abnormal fetal development and fetal addiction; placental abruption)

When the placental abruption happens, the fetus has to be delivered because it can no longer survive in the uterus (no blood supply anymore). So it has to come out, and it will happen earlier than it would if there was no abruption ->premature.

Hey just have two questions:
One was a man coming into the ER with decreased O2 content in arterial and mixed venous O2 content. And it asked what is likely explanation to these findings.

I think the answer was High Altitude? Not sure about how to go about answering that one.

At high altitudes, the PaO2 can never be normal, so you can eliminate that option. Since you'd be breathing in air that has lower PO2, both PaO2 and CaO2 would be low. In that question, PaO2 was near normal, and CaO2 was low. Has to be anemia. (I think I'm remembering the details of the question right?).

The "football player who is the star wrestler also and asks about his breasts after his dad leaves the room question" was confusing to me because I couldn't figure out if he was on steroids but didn't want his dad to know OR if NBME just wanted us to know that gyncomastia is normal at 18. The latter was the answer on a previous NBME. What did yall think?

Some people already mentioned it, but "normal" gynecomastia of puberty wouldn't occur by the time Tanner stage 5 is reached. Also, if gynecomastia does occur during puberty, I believe its unilateral. This guy had bilateral gynecomastia, so you have to lean towards steroid use.

 

[Akr]

When the placental abruption happens, the fetus has to be delivered because it can no longer survive in the uterus (no blood supply anymore). So it has to come out, and it will happen earlier than it would if there was no abruption ->premature. Thanks! This makes a lot more sense than what I was thinking, which was just general vasoconstriction decreasing perfusion of the placenta and baby. I guess that would instead more closely describe pre-eclampsia

Some people already mentioned it, but "normal" gynecomastia of puberty wouldn't occur by the time Tanner stage 5 is reached. Also, if gynecomastia does occur during puberty, I believe its unilateral. This guy had bilateral gynecomastia, so you have to lean towards steroid use. I had gotten this wrong too, thanks for this explanation!

Just wanted to add for this thread that I came across this on a Google-search... http://quizlet.com/23071157/nbme-15-review-flash-cards/

 

[Jonari]

How about the question regarding the A-a gradient. Can anybody provide tips on how to work it out, for future reference. I came down to A or B, both the PCO2 and PO2 values looked good for the condition, but couldn't figure out the right choice for the A-a gradient...

 

[Akr]

How about the question regarding the A-a gradient. Can anybody provide tips on how to work it out, for future reference. I came down to A or B, both the PCO2 and PO2 values looked good for the condition, but couldn't figure out the right choice for the A-a gradient...

From what little I remember of that question... The gradient (PAO2 that they gave an estimated value of - PaO2, from ABG) was under 15, which means diffusion across the lungs was normal. That was my first mistake, thinking it was an abnormal gradient. Thankfully we didn't have to estimate PAO2 ourselves, I don't have the alveolar gas equation down either...

Then, the PAO2 was abnormal too (due to abnormal ventilation), which I also didn't recognize. So in this case, I don't think the PCO2 was even very critical information.

 

[Akr]

The last of my incorrects that I haven't really cleared up yet...

Boy with precocious puberty, how would his height be affected if untreated? I forgot about early epiphyseal plate closure due to testosterone and said he'd be tall in adulthood, so I know why that answer was wrong. But would he still be taller than average in childhood? And would the trend be similar for girls with precocious puberty?

 

[CrouchingLiger]

Yeah, he'd be taller than average in childhood (think growth spurt of puberty, happening earlier). But then as you said, early epiphyseal plate closure means shorter than average as an adult.

 

[strive01]

ah so disappointed score dropped a 10-15 points from past NBMEs ;(
any help clearing up these concepts would be appreciated!!

1. invasive SCC at cervix spreads?? I put superficial lymph node but that was wrong? options: femoral, inferior mesenteric, internal illiac, lumbar
(FA says proximal vag/uterus goes to obterator, external illiac and h ypogastric..meh)

2. woman with gram neg rods in spetum. chest x-ray shows new patchy R lower lobe infiltrate. What is the endogenous chemoattractant for recruitment of leukocytes to site of inflammation? I put N-formyl methionine terminal amino peptides because of the bacteria. but i guess its c5a (which is your classic chemoattractant i know) - why is the N-formyl methionine not correct?


3. I still dont understand why its the angular gyrus for the man that cant comphrend and speaks with many grammatical errors?

4. holosystolic mumur best heard at the left axiallary line? ugh, why did I put tricuspid regur? its mitral regurg right?

5. woman with a parathyroid adenoma would have decreased...? Ca abs from gut, Ca conc in feces, Ca conc in Muscle, Ca conc in plasma, Ca loss in bone

6. pedigree of hereditary telangiectasa - the woman with the arrow doesnt have it but the kid does? is it genetic mosaicism, incomplete penetrance, nonpaternity, somatic mosaicism, variable expressivity?

7. 38 y.o homeless man feeling ill after friend made alcoholic beverage.. what does the antidote mxn? I put inhibits cytochome p450 A4, blocking conversion of formaldehye to formic acid but i guess thats wrong =/

8. healthy 3 y/o with cleft lip and palate? what is the mode of inheritance?

9.during muscle contract, intracellular calcium is decreased after a substance is administered - why? Ach release is increased, depolarization along T tubules is enhanced, mylosin binding sites on actin remain covered by troponin C, Na influx is increased (i was thinking about the Na/Ca channels STUPID =/) tropomyosin is detached from actin

10. man has cancer at the head of the pancreas. what is at greatest risk of developing? bipolar disorder, MDD, memory impairment, personality change, schizophreniform disorder?

11. man with wt loss, abd pain, diarrhea. stool shows increased excretion of neutral fat and muscle fiber. x-loyse test normal, no abnormalities on intestinal biopsy -- pt will most likely respond favorabily to? Abx, azathioprine, intrinsic factor, pancreatic enzymes, prednisone?

12. 2 week hx of SOB.. stress cardio shows hypokinesis of the posterior left ventricle with increasing activity levels? its not increased left ventricle end diastolic pressure.. is it disruption of symp N to LV, extravascualr compression of cornary arterires, increased myocardial o2 consumption or stensosi of R coronary artery?

 

[chettybangbang]

ah so disappointed score dropped a 10-15 points from past NBMEs ;(
any help clearing up these concepts would be appreciated!!

1. invasive SCC at cervix spreads?? I put superficial lymph node but that was wrong? options: femoral, inferior mesenteric, internal illiac, lumbar
(FA says proximal vag/uterus goes to obterator, external illiac and h ypogastric..meh)

2. woman with gram neg rods in spetum. chest x-ray shows new patchy R lower lobe infiltrate. What is the endogenous chemoattractant for recruitment of leukocytes to site of inflammation? I put N-formyl methionine terminal amino peptides because of the bacteria. but i guess its c5a (which is your classic chemoattractant i know) - why is the N-formyl methionine not correct?


3. I still dont understand why its the angular gyrus for the man that cant comphrend and speaks with many grammatical errors? Thought this was a lesion to wernicke's area? not completly sure

4. holosystolic mumur best heard at the left axiallary line? ugh, why did I put tricuspid regur? its mitral regurg right? Don't remember

5. woman with a parathyroid adenoma would have decreased...? Ca abs from gut, Ca conc in feces, Ca conc in Muscle, Ca conc in plasma, Ca loss in bone

6. pedigree of hereditary telangiectasa - the woman with the arrow doesnt have it but the kid does? is it genetic mosaicism, incomplete penetrance i believe, nonpaternity, somatic mosaicism, variable expressivity?

7. 38 y.o homeless man feeling ill after friend made alcoholic beverage.. what does the antidote mxn? I put inhibits cytochome p450 A4, blocking conversion of formaldehye to formic acid but i guess thats wrong =/ Alcohol Dehydrogenase - Fomepizole

8. healthy 3 y/o with cleft lip and palate? what is the mode of inheritance? Dont remember, but I think its polygenic?

9.during muscle contract, intracellular calcium is decreased after a substance is administered - why? Ach release is increased, depolarization along T tubules is enhanced, mylosin binding sites on actin remain covered by troponin C, Na influx is increased (i was thinking about the Na/Ca channels STUPID =/) tropomyosin is detached from actin

10. man has cancer at the head of the pancreas. what is at greatest risk of developing? bipolar disorder, MDD, memory impairment, personality change, i believe this is the answer as part of hepatic encephalopathy, but I also missed this one, schizophreniform disorder?

11. man with wt loss, abd pain, diarrhea. stool shows increased excretion of neutral fat and muscle fiber. x-loyse test normal, no abnormalities on intestinal biopsy -- pt will most likely respond favorabily to? Abx, azathioprine, intrinsic factor, pancreatic enzymes, dont remember, but protein (muscle fibers in feces) means enzymes are not breaking it down, prednisone?

12. 2 week hx of SOB.. stress cardio shows hypokinesis of the posterior left ventricle with increasing activity levels? its not increased left ventricle end diastolic pressure.. is it disruption of symp N to LV, extravascualr compression of cornary arterires, increased myocardial o2 consumption or stensosi of R coronary artery?

Just what i remember from the top of my head. May not be 100% correct.

 

[Akr]

I tried to comment on a few. Let me know if I can clarify on anything... Chin up and keep pushing through!

ah so disappointed score dropped a 10-15 points from past NBMEs ;(
any help clearing up these concepts would be appreciated!!

1. invasive SCC at cervix spreads?? I put superficial lymph node but that was wrong? options: femoral, inferior mesenteric, internal illiac, lumbar
(FA says proximal vag/uterus goes to obterator, external illiac and h ypogastric..meh)

2. woman with gram neg rods in spetum. chest x-ray shows new patchy R lower lobe infiltrate. What is the endogenous chemoattractant for recruitment of leukocytes to site of inflammation? I put N-formyl methionine terminal amino peptides because of the bacteria. but i guess its c5a (which is your classic chemoattractant i know) - why is the N-formyl methionine not correct?


3. I still dont understand why its the angular gyrus for the man that cant comphrend and speaks with many grammatical errors? Wernicke's aphasia: the motor cortex responsible for producing speech output is fine, but a lesion around the associative auditory cortex (superior temporal gyrus) messes up the incoming stuff, i.e. understanding what he has heard. The angular gyrus is slightly above that area, and similarly has to do with understanding. Not much about it in First Aid though, maybe I need to dig up my old neuro notes... Does that answer your question?

4. holosystolic mumur best heard at the left axiallary line? ugh, why did I put tricuspid regur? its mitral regurg right? Yep

5. woman with a parathyroid adenoma would have decreased...? Ca abs from gut, Ca conc in feces, because PTH increases Ca absorption from the gut Ca conc in Muscle, Ca conc in plasma, Ca loss in bone

6. pedigree of hereditary telangiectasa - the woman with the arrow doesnt have it but the kid does? is it genetic mosaicism, incomplete penetrance, nonpaternity, somatic mosaicism, variable expressivity?

7. 38 y.o homeless man feeling ill after friend made alcoholic beverage.. what does the antidote mxn? I put inhibits cytochome p450 A4, blocking conversion of formaldehye to formic acid but i guess thats wrong =/ I think I saw this in a House episode once Antidote for methanol is ethanol - competes with methanol for the enzyme that breaks it down into the really dangerous intermediate, formaldehyde

8. healthy 3 y/o with cleft lip and palate? what is the mode of inheritance?

9.during muscle contract, intracellular calcium is decreased after a substance is administered - why? Ach release is increased, depolarization along T tubules is enhanced, mylosin binding sites on actin remain covered by troponin C, Na influx is increased (i was thinking about the Na/Ca channels STUPID =/) tropomyosin is detached from actin - they asked why does muscle not contract if intracellular calcium is decreased. Calcium would normally bind Trop C to get the contraction going...

10. man has cancer at the head of the pancreas. what is at greatest risk of developing? bipolar disorder, MDD - I just figured with devastating news, it would be either this or personality change., memory impairment, personality change, schizophreniform disorder?

11. man with wt loss, abd pain, diarrhea. stool shows increased excretion of neutral fat and muscle fiber. x-loyse test normal, no abnormalities on intestinal biopsy -- pt will most likely respond favorabily to? Abx, azathioprine, intrinsic factor, pancreatic enzymes - mostly because intestinal biopsy was normal, which eliminated some other things I was thinking of. I still can't explain the muscle fiber in the stool though prednisone?

12. 2 week hx of SOB.. stress cardio shows hypokinesis of the posterior left ventricle with increasing activity levels? its not increased left ventricle end diastolic pressure.. is it disruption of symp N to LV, extravascualr compression of cornary arterires, increased myocardial o2 consumption - I ALMOST chose this, but had to think really hard to rule it out or stenosis of R coronary artery - yes, think of what supplies the back of the left ventricle. Most people are right-dominant in that coronary supply.

 

[Akr]

Yeah, he'd be taller than average in childhood (think growth spurt of puberty, happening earlier). But then as you said, early epiphyseal plate closure means shorter than average as an adult.

Got it, thanks! Hopefully I'll remember this concept now...

 

[strive01]

1. person had diarrhea from salmonella enterica and in 36 hrs within 36 hrs but persist in a milder form for several more days -- what is most likely to occur in this pt if treated with abx? anaphylaxis as a result of abx hypersensitivity, decreased risk of endocarditis, decreased risk for hemolytic uremic syndrome, establishment of a chronic carrier state in spleen, prolonged fecal excretion of the organism (this answer seemed weird to me - i guess the prolonged threw me off but im guessing that was correct?

2. the guy that smells of burnt almonds and is NONcynaotic is still tripping me up. It sounds like CO poisiong and I put hyperbaric oxygen but thats wrong! the other answers are: amyl nitrate, EPO, ethanol, physostigmine

3.would someone mind explaining the basics behind distinguishing incomplete penetrance from gondal moacism on a pedigree?

4. for the alcohol poisoning question and giving an antidote- the options were: blocks methanol in the GI tract and decreases its absorption, blocks tubular reabsorption and enhances urinary elimination of methanol, enhances metabolism of methanol by alcohol dehydrogenase and cytochrome p450 3A4, and inhibits alcohol dehydrogenase, blocking its conversion of methanol to foraldehyde

 

[Akr]

Added in bold...

1. person had diarrhea from salmonella enterica and in 36 hrs within 36 hrs but persist in a milder form for several more days -- what is most likely to occur in this pt if treated with abx? anaphylaxis as a result of abx hypersensitivity, decreased risk of endocarditis, decreased risk for hemolytic uremic syndrome, establishment of a chronic carrier state in spleen, prolonged fecal excretion of the organism (this answer seemed weird to me - i guess the prolonged threw me off but im guessing that was correct?) Yes

2. the guy that smells of burnt almonds and is NONcynaotic is still tripping me up. It sounds like CO poisiong and I put hyperbaric oxygen but thats wrong! the other answers are: amyl nitrate - I know this isn't very helpful... but my path teacher taught cyanide poisoning as causing CHERRY RED skin discoloration, just like CO does. I just went back to my powerpoints to double-check. I know that's opposite to what Wikipedia says, and to the name CYANide... But if it's true anyway, the main differentiating factor for cyanide poisoning vs. CO is the burnt almond smell , EPO, ethanol, physostigmine

3.would someone mind explaining the basics behind distinguishing incomplete penetrance from gondal moacism on a pedigree?

4. for the alcohol poisoning question and giving an antidote- the options were: blocks methanol in the GI tract and decreases its absorption, blocks tubular reabsorption and enhances urinary elimination of methanol, enhances metabolism of methanol by alcohol dehydrogenase and cytochrome p450 3A4, and inhibits alcohol dehydrogenase, blocking its conversion of methanol to foraldehyde

 

[CrouchingLiger]

Time for me to add in a few questions, I haven't been able to find the answers to these anywhere and I'd appreciate any help. Thanks!

62 y.o. women with pale mucous membranes and tenderness over lumbar spine and upper humerus. labs show anemia, hypercalcemia, and hypoalbuminemia. She has lytic bone lesions with areas of uptake on bone scan. It has a picture of her blood smear, which I couldn't really interpret very well (although I think I see tear drop-shaped cells, they could also be rouleaux which would point to B, but I'm not convinced about that). It asks for the most likely diagnosis:
A: AML (wrong)
B: Multiple Myeloma (Now this looks like it could be right, but I still don't feel like there's enough info for me to pick it)
C: Non-hodgkin lymphoma
D: Osteomalacia
E: Osteosarcoma

2 month old with hypotonia, poor feeding. PE has large fontanels, midface hypoplasia, hepatomegaly, cryptorchidism. Serum has high very-long-chain fatty acids, phytanic acid, and pipecolic acid. What organelle is absent from hepatocytes on biopsy?
A: ER
B: Lysosome (wrong)
C: Mitochondria
D: Nucleoli
E: Peroxisomes (I'm guessing this is it?)

This was asked but never had a consensus on an answer: man has cancer at the head of the pancreas. what is at greatest risk of developing? I saw two people above suggest that its either B/D, but I don't know which one from those. Not sure what they are going for with this question.
A: bipolar disorder
B: MDD
C: memory impairment (wrong)
D: personality change
E: schizophreniform disorder?

There was a question about a basketball player who uses cocaine recreationally, and developed an acute episode with hyperresonance in the lung and decreased breath sounds. The answer was pneumothorax, but what did the cocaine have to do with it? Anything, or is unrelated?

 

[Akr]

Time for me to add in a few questions, I haven't been able to find the answers to these anywhere and I'd appreciate any help. Thanks!

62 y.o. women with pale mucous membranes and tenderness over lumbar spine and upper humerus. labs show anemia, hypercalcemia, and hypoalbuminemia. She has lytic bone lesions with areas of uptake on bone scan. It has a picture of her blood smear, which I couldn't really interpret very well (although I think I see tear drop-shaped cells, they could also be rouleaux which would point to B, but I'm not convinced about that). It asks for the most likely diagnosis:
A: AML (wrong)
B: Multiple Myeloma (Now this looks like it could be right, but I still don't feel like there's enough info for me to pick it)
C: Non-hodgkin lymphoma
D: Osteomalacia
E: Osteosarcoma

2 month old with hypotonia, poor feeding. PE has large fontanels, midface hypoplasia, hepatomegaly, cryptorchidism. Serum has high very-long-chain fatty acids, phytanic acid, and pipecolic acid. What organelle is absent from hepatocytes on biopsy?
A: ER
B: Lysosome (wrong)
C: Mitochondria
D: Nucleoli
E: Peroxisomes (I'm guessing this is it?)

This was asked but never had a consensus on an answer: man has cancer at the head of the pancreas. what is at greatest risk of developing? I saw two people above suggest that its either B/D, but I don't know which one from those. Not sure what they are going for with this question.
A: bipolar disorder
B: MDD
C: memory impairment (wrong)
D: personality change
E: schizophreniform disorder?

There was a question about a basketball player who uses cocaine recreationally, and developed an acute episode with hyperresonance in the lung and decreased breath sounds. The answer was pneumothorax, but what did the cocaine have to do with it? Anything, or is unrelated?

First one: multiple myeloma, mainly because the lytic bone lesions (and age I guess).

Second one: yep, peroxisomes break down VLCFAs.

Third: I definitely got it right, and I'm >99% sure I answered MDD.

Fourth: I'm betting the cocaine was a distractor, never heard of it contributing to pneumothorax...

 

[RIPSanto]

Did this form have a question about NADH and ETOH metabolsm/ fatty liver change? If so, does anyone have/remember the gist of the question and want to explain?

 

[chettybangbang]

Can someone help me out with a question, I think im getting tripped up on PTH and its actions.
A question asks about a woman with decreased bone density on DEXA and it asks if the following variables increase or decrease.

Osteoblast Activity / Osteoclast Activity / Receptor Activator of Nucelear Factor kB Ligand (RANKL) concentration

So its osteoporsis so PTH is probably elevated correct?
Which means Osteoblast activity decreases, Oseoclast Increases, and RANKL increases as well right?