qbank errata thread

[maverick_pkg]

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1) qbank says that most commonly sq. cell cancer in oral cavity is on lower lips while Goljan and BRS say that tongue is most common followed by lower lip.

so whats correct?





2) another question: Patients with functioning pituitary adenomas are most likely to present with the following:

a) Acromegaly
b) Galactorrhea
etc

qbank says galactorrhea. Now prolactinoma is the commonest functioning pituitary adenomas while GH secreting adenoma is the 2nd commonest. however, galactorrhea is not present in males (ruling out 50% cases) coz they dont have sufficient terminal lobule (as mentioned by Goljan) so shouldnt acromegaly be more common than galactorrhea




3)qbank says that edward's syndrome has hypotonia? doesnt edwards have hypertonia?



4) another question:-
qbank says that insulin resistance is due to Antibodies blocking insulin from binding to its receptor. Kaplan physio says that insulin resistance due to downregulation of receptors due to chronically activated plasma insulin. Kaplan is contradicting itself!!!



5) a 12 yr old girl has ASD. what is the most common cause:

a) failure of formation of septum primum
b) failure of formation of septum secundum
c) incomplete adhesion between septum primum and secundum

qbank says c AND in kaplan lectures the guy taught us b. what r ur opinions



6) A man gets a injury to his neck/sup medistinum wrestling. Which structure is most likely to get injured

a) Esophagus
b) Trachea
c) Sup vena cava
etc

The qbank says that its trachea as it is more superficial to esophagus and sup vena cava. However, actually SVC is more superficial to trachea. so isnt qbank answer wrong

 

[maverick_pkg]

Ques 7) Examination of per smear demonstrates large no of target cells. Further work up would reveal:

a) Abnormal Hb synthesis
b) Cells that sickle when exposed to low oxygen tension
etc

according to qbank Target cells are seen in thalassemia, Hb C and liver disease, and not in sickle cell anemia - according to Goljan they r present in sickle cell also as it is a hemoglobinopathy

 

[KerleyB]

I gotta tell ya, I think you may be overthinking some of this stuff. You clearly have a good knowledge base, but you may be "overusing" it. Eg... texts that tell you the most common location for a oral squam is the ... (tongue or lower lip etc) is to help you remember what to think of when a cigar smoking sailor comes to you with a crusty, oozing, enlarging "scab" on his lower lip. Learn the broad strokes very well, and try to remember classic details. Hope that helps.

 

[maverick_pkg]

I gotta tell ya, I think you may be overthinking some of this stuff. You clearly have a good knowledge base, but you may be "overusing" it. Eg... texts that tell you the most common location for a oral squam is the ... (tongue or lower lip etc) is to help you remember what to think of when a cigar smoking sailor comes to you with a crusty, oozing, enlarging "scab" on his lower lip. Learn the broad strokes very well, and try to remember classic details. Hope that helps.

hmmm but the problem that i face now is when books i studied from eg Goljan and BRS differ from qbank. then what 2 believe coz questions r going wrong in qbank with the info provided in those books. then for the actual exam, which one should i follow if similar question comes?

 

[Ramoray]

1) qbank says that most commonly sq. cell cancer in oral cavity is on lower lips while Goljan and BRS say that tongue is most common followed by lower lip.

so whats correct?

Actually neither is correct which shows why the poster below is correct, dont lose sight of the big picture which is that 90 percent of head/neck malig cancers are sq. cell carcinomas esp oral so if you have malig canc of oral its sq cell. BTW its not just smokers etc but any dentures or mouth pieces that chornically irrated mucosa can be a cancer promoter LT in elderly





2) another question: Patients with functioning pituitary adenomas are most likely to present with the following:

a) Acromegaly
b) Galactorrhea
etc

qbank says galactorrhea. Now prolactinoma is the commonest functioning pituitary adenomas while GH secreting adenoma is the 2nd commonest. however, galactorrhea is not present in males (ruling out 50% cases) coz they dont have sufficient terminal lobule (as mentioned by Goljan) so shouldnt acromegaly be more common than galactorrhea

I think this is just a bad question, what they tried to do is take it s tep further and instead of asking the most common pit adenom, they meant to say what is the presentation of the most common type of adenoma or something. just a bad question probably wont show up like that i assume



3)qbank says that edward's syndrome has hypotonia? doesnt edwards have hypertonia?

again bad questions, edwards actually has BOTH- immediatly after birth hypotonia is displayed, and if they survivie, a few months later they have the characteristic clenched fists with hypertonia. It is as their nervous system develops they progress to hypertonia

4) another question:-
qbank says that insulin resistance is due to Antibodies blocking insulin from binding to its receptor. Kaplan physio says that insulin resistance due to downregulation of receptors due to chronically activated plasma insulin. Kaplan is contradicting itself!!!
It def. has nothing to due with antibodies. Ins resistance, they still dont knwo exactly so you would never have to knwo an exact mechanism but the most popular view now is that you are right it is:
1. Downregulation of receptors but more importantly a decrease in signaling between receptor and kinases in cell therefore loss of receptor signalling. Its in obese people often and 2 reasons why are obese have higher levels of triglycerides and free fatty acids in serum which both act on signal proteins in the insulin recepto path and downregulate signalling. The other is increased adipose tissue and obese people are thought to have lower levels of leptin. Leptin is a powerful insulin sensitizing adipokine and the loss of leptin or decreased amt. leads to resistance. bottom line antibodies have nothing to do with it.

5) a 12 yr old girl has ASD. what is the most common cause:

a) failure of formation of septum primum
b) failure of formation of septum secundum
c) incomplete adhesion between septum primum and secundum

qbank says c AND in kaplan lectures the guy taught us b. what r ur opinions

The most common asd is a foreman secundum defect can be caused by multiple things, c and b could be correct, there is no one reason why someone gets a secundum asd

6) A man gets a injury to his neck/sup medistinum wrestling. Which structure is most likely to get injured

a) Esophagus
b) Trachea
c) Sup vena cava
etc

The qbank says that its trachea as it is more superficial to esophagus and sup vena cava. However, actually SVC is more superficial to trachea. so isnt qbank answer wrong
You have to remeber the area you are looking at, the nech/sup medias. would refer to a more midline, since it refered to neck and high up in the sup. mediastinum since it refered to neck. At that area the trachea is the predom structure. As you get to the sternal angle and the bottom boundry of the sup. medistinum, the SVC forms near the aortic arch level and it IS in the sup medistinum BUT it is to the right side and very low in the sup med. so there is really no way to injure that since any injury to that area would hit the arch as well. Look at any atlas, a midline neck/sup media injury is right on the trachea. the SVC is just too low and left for that descritpion

7. The question about Target cells. It is classic ofr Beta thal. and is caused by alpha chains forming INSOLUBLE inclusions in the rbc, since they are insoluble they surround the pereriphery, getting as close as they can to the menbrane which is also insoluble in aqueous(its lipids in the interior) so that is as close as the inclusions can get to being soluble by being near a membrane with an insoluble interior. So since the perfiphery is filled with inclusions that pushes the hemoglobin that is made into the center, therefore you get a center of hemoglobin which looks like a target. This would make no sense in sickle cell, the hemoglobin changes into odd shapes and is dispersed in the cell, no way it could be target shaped

 

[north2southOMFS]

1) qbank says that most commonly sq. cell cancer in oral cavity is on lower lips while Goljan and BRS say that tongue is most common followed by lower lip.

so whats correct?




6) A man gets a injury to his neck/sup medistinum wrestling. Which structure is most likely to get injured

a) Esophagus
b) Trachea
c) Sup vena cava
etc

The qbank says that its trachea as it is more superficial to esophagus and sup vena cava. However, actually SVC is more superficial to trachea. so isnt qbank answer wrong

Here's all i know.

for number 1, Your mixing two types of cancer together. Oral cancer and lip cancer are separate types of cancer in most head/neck schools of thougt. ( this coming from an ORAL and MAXILLOFACIAL surgery resident-Me.) They beat into our heads that they are two totally different types of cancers because they behave very different. (Oral cancer is MUCH worse to have) but for clinical purposes, lower lip cancer is much more prevalent than all oral SCC cancers, and it almost always is SCC. Oral cancer on the other hand is also almost always SCC and mostly occurs on the lateral boerder of the tongue, followed by ventral toungue/floor of mouth, then retromolar trigone.....etc.

Hope that helps...


As for question 6 about a neck/mediastinal injury....

I think you would have to be more specific of wehre the injury occurs because in the neck of course the trachea is more superficial, plus there is no freakin SVC in the neck, its still a jugular vein! And yes once below the clavicles the SVC may be more superficial, but still hard to injure without injuring other anatomy first. (like the aorta!).
I'd go with trachea without a doubt.


Ok, now back to more intense studying..............................

 

[maverick_pkg]

thanks for the help guys 😀

 

[dynx]

5) a 12 yr old girl has ASD. what is the most common cause:

a) failure of formation of septum primum
b) failure of formation of septum secundum
c) incomplete adhesion between septum primum and secundum

qbank says c AND in kaplan lectures the guy taught us b. what r ur opinions

I may be pulling this out of my ass, but I think your Kaplan guy is right. I think that there is a distinction made in Robbins that a patent foramen Ovale (from C) is not considered a true ASD.