Question from Kaplan Simulation Exam2

[Convalaria]

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well, this one is something....

50 yo woman with a1 antitrypsin deficiency undergoes a double lung transplant for severe emphysema. She doesn't smoke. One year later she comes to ED bcs of acute shortness of breath. X ray shows patchy infiltrates. Which of the following is the most likely cause of the patient's symptoms?

a. acute rejection
b. asthma
c. bronchoectasis
d. oat cell carcinoma
e. reccurent emphysema

I want to hear your opinions and thoughts. Since for exam questions kaplan doesn't provide with info on what percent of students got it right, I'm just curious whether I'm the only one who made a mistake here.
I got this question wrong though answer seemed quite obvious to me

 

[Convalaria]

any thoughts?

 

[Convalaria]

another question:

37 yo woman who had poor prenatal care gives birth to a newborn girl. Phys.examination shows herniation of the meninges and spinal cord through posterior vertebral defect. Which of the following additional findings is most likely in this patient?

a. Arnold-Chiari malformation - wrong
b. Dandy-Walker anomaly - correct
c. Holoprosencephaly
d. Lissencephaly
e. Spina bifida occulta

I always thought that meningomyelocele is frequently associated with Arnold-Chiari malformation.
But the correct answer is Dandy-Walker anomaly. Isn't it wrong??

 

[loveoforganic]

another question:

37 yo woman who had poor prenatal care gives birth to a newborn girl. Phys.examination shows herniation of the meninges and spinal cord through posterior vertebral defect. Which of the following additional findings is most likely in this patient?

a. Arnold-Chiari malformation - wrong
b. Dandy-Walker anomaly - correct
c. Holoprosencephaly
d. Lissencephaly
e. Spina bifida occulta

I always thought that meningomyelocele is frequently associated with Arnold-Chiari malformation.
But the correct answer is Dandy-Walker anomaly. Isn't it wrong??

I don't know about DW, but there is definitely an association between arnold chiari and meningomyelocele (and obviously syringomyelia)

 

[Girfaroo]

well, this one is something....

50 yo woman with a1 antitrypsin deficiency undergoes a double lung transplant for severe emphysema. She doesn't smoke. One year later she comes to ED bcs of acute shortness of breath. X ray shows patchy infiltrates. Which of the following is the most likely cause of the patient's symptoms?

a. acute rejection
b. asthma
c. bronchoectasis
d. oat cell carcinoma
e. reccurent emphysema

I want to hear your opinions and thoughts. Since for exam questions kaplan doesn't provide with info on what percent of students got it right, I'm just curious whether I'm the only one who made a mistake here.
I got this question wrong though answer seemed quite obvious to me

It's not recurrent emphysema? Or is it assumed that she is taking care of it, and she just needed the transplants because her lungs were so damaged?

 

[Convalaria]

It's not recurrent emphysema? Or is it assumed that she is taking care of it, and she just needed the transplants because her lungs were so damaged?

nope
it was A. Acute rejection. and this answer is just ridiculous
they say that after a year it can be still acute...whatever..

 

[thinkenergy]

I went w/ recurrent emphysema too, thought the time course was too long to be acute rejection, also the fact that she has anti trypsin def makes her more likely to suffer emphysema even w/ a new lung.

 

[Convalaria]

I went w/ recurrent emphysema too, thought the time course was too long to be acute rejection, also the fact that she has anti trypsin def makes her more likely to suffer emphysema even w/ a new lung.

I thought that patient had chronic rejection, and since chronic rejection of lungs usually affects airways, I chose c.bronchoectasis that might cause patchy infiltrates on X-ray

 

[thinkenergy]

Thought about that at first, looked at ACs but chronic rejection wasn't one of them, I don't think chronic rejection results in bronchiectasis (which results from chronic necrotizing infllammation)

 

[HelpPleaseMD]

its associated with arnold chari II. I is benign

 

[ijn]

This is why Kaplan is ******ed. On STEP 1 they're not going to give you a question where it hinges on you knowing the difference between a type I vs II vs III malformation. That kind of question belongs on a Pediatrics fellowship examination.

 

[thinkenergy]

Agree, I feel sometimes Kaplan questions are written in such way to solely trick you not testing your knowledge.

 

[AndyRSC]

In the first question, there are several clues. First, none of the conditions except rejection would classically present with patchy infiltrates on CXR. Second, you pretty much expect rejection with a transplant. The time-frame it gives, however, is misleading. Acute rejection can occur that late, but not classically. Was there anymore to the question? Did she stop or run out of immunosuppressants?

The second question is even worse. Dandy-Walker can occur with spina bifida, but not with anywhere near the frequency that Arnold-Chiari II does, which is a well-known and classic association.

 

[XCdude]

This question is straight out of first aide. Dand-walker: large posterior fossa,, no vermis and cystic elargment of 4th ventricle. Can lead to hydrocephalus and spina bifida.

If it were AC type II, there would be a constellation of additional findings (herniation of tonsil, hydrocephalus, aquaductal stenosis, and Cspine syrinx.

Also, due to the fact that there are two types of AC malformations with AC type I much more common than AC II, and DW being more common than AC II, and no additional neural defects, DW is the most likely dx.

Any one know how your performance on the sim exams correlates to step 1 performance?