- Joined
- Nov 22, 2016
- Messages
- 76
- Reaction score
- 38
Reviewed my mistakes. Some I still unable to figure out why the answer isn't what I thought.
1-50 A 65-year-old woman is being treated in the hospital for widely metastatic breast cancer unresponsive to chemotherapy. She has never married and has no children or siblings. Throughout her illness, another woman she had introduced as "my close friend," has been with her during hospitalizations and office visits. The patient is moved to an inpatient hospice after she decides she wants no further curative therapy. She and her friend appear very distressed when they read a sign outside the hospice unit that states only family members are permitted to stay after visiting hours. Her friend says, "We can't bear to be apart. It would be cruel to separate us now." Which of the following responses by the physician is most appropriate?
A"Don't worry. I'll call you right away if something happens to your friend. Just leave your number with the nurses."
B"I'm sorry, but only family is allowed to stay with patients in the hospital. You will have to leave after your 15 minutes are up."
C"The two of you seem to have a very important relationship. Of course you may stay together."
D"Visiting hours are posted outside. You are welcome during any of those times. I'm sorry, but an exception cannot be made in your case."
E"Well, I guess we could bend the rules just this time, but if anyone asks, you're her sister. Does that sound OK?"
I chose D. I was thinking that we're to adhere to rule. C seems like exception to be made, along with E. Does D sound too indifferent to patient?
2-30 A 6 week old girl is brought to the physician by her mother because of a 6 day history of vomiting a small amount of milk 2-3 times daily. She appears well. She is at the 50th percentile for length and weight. Physical examination shows no abnormalities. Which of the following is the most likely cause of this patient's findings?
a) Esophageal spasm
b) Gut malrotation
c) Immature lower esophageal sphincter
d) Neuromuscular abnormality of the esophagus
e) Pyloric stenosis
f) Tracheoesophageal fistula
I really didn't get this one.
2-50 A new compound is taken up by bacterial cells. No energy is necessary for uptake, and the compound is not concentrated in the cell. Which of the following best describes this mechanism of transport?
a) ATP mediated active transport
b) Carrier mediated diffusion
c) Group translocation
d) Phosphorylation linked transport
e) Proton gradient mediated transport
3-2 47 year old woman with psoriasis comes for followup. At her last appointment she was given several topical creams, which must be applied in a specified sequence twice a day. No improvement is apparent in the current appointment. What would be the best way to begin the discussion of this patient's compliance with therapy ?
a. Did you use the creams twice daily ?
b. How many tubes did you use in the last month ?
c. How often did you skip treatments ?
d. Most people find it difficult to stick to a routine. How did you do ?
e. Using something twice daily can be difficult. I assume you are like most people who miss at least 10% of treatments.
Was stuck between B and D. Then I thought D seems relatively judgemental, so I chose B , which I thought is a more open ended response.
4-15 6-Mercaptopurine (6-MP) used to treat acute lymphoblastic leukemia (ALL). 6-MP acted on by enzymes to make 6-thioguanine nucleotides (6-TGN). Efficacy and toxicity of 6-MP correlated with 6-TGN. 6-MP acted on by xanthine oxidase (XO), thiopurine methyltransferase (TPMT), leading to inactive metabolites. Which are clinical consequences of ALL patients homozygous for low-activity alleles of TPMT?
A) They must be given normal dose of 6-MP
B)They must be given decreased dose of 6-MP
C)They must be given increased dose of 6-MP
D)They must be given injection w/ XO if treated with 6-MP
Was stuck between B and D. Ended up choosing D and wrong. Was thinking if we decrease dose of 6-MP, wouldn't his therapeutic effect decline? What if we supply him some XO considering that he's deficient of TPMT?
4-16 A physician is sad because he has to inform a patient of progression of carcinoma to terminal phase. When the patient sees the physician's face, he begins to cry and says, "it's bad news, isn't it? Which of the following responses is most appropriate?
A) How have you been since the last time I saw you?
B) Let's talk about the positive aspects first.
C) Look on the bright side of things.
D) Tell me how you are feeling.
E) There are other people who have it a lot worse than you.
F) Yes, it is.
G) You've had several years better off than many others with this disease.
I chose A and wrong. Was stuck between A and D. I found somewhere somebody say it's F, which seemed cold to me. What do you guys think?
4-19 15 yo f with 1 day h/o redness and painful skin following sunbathing. she used sunblock every few hours. P/E shows severe erythem of back and extremities. there are no blisters. Dx?
A)allergic reaction to sun
B)first degree burn
C)rhus dermatitis
D)2nd degree burn
E)3rd degree burn
Just wonder how to distinguish between 1st degree burn and allergic reaction. Should the latter have quicker onset?
4-40 14 year old boy brought into the physician by his mom bcuz of daily headaches for 2 onths. The headaches are described as bilateral aching in the temples. His mom states that he also "has not been himself" for the past few mos. he seems more confused, often forgetting names, dates, and places and he is clumsy with frequent falls. his school performance dropped. P/E shows broadbased, ataxic gait. He is alert and oriented to person place and time but he is slow to answer questions. Chronic abuse of which of the following substances is most likely cause of this patients condition?
a)cocaine
b)ethanol
c)inhaled glue
d)methamphetamies
e)PCP
I chose B because the boy has confusion, ataxia, which lead me to think thiamine deficiency commonly caused by alcoholism. But NBME said I'm wrong. I found that the answer is probably C. I didn't find glue toxicity in First Aid, nor can I understand why answer B should be excluded
4-50 A 15-year-old girl comes to the physician's office for a health maintenance examination Her mother was recently diagnosed with squamous cell carcinoma of the face and her maternal grandfather died of metastatic melanoma. During the visit, the physician advises her about methods of photoprotection including daily use of a sunscreen. In a patient of this age which of the following factors is most likely to predict compliance with photoprotection?
a Ability to tan
b Advice of the physician to wear sunscreen
c Concern about premature aging of skin
d Desire to prevent sunburn
e Family history of skin cancer
f Use of sunscreen by her peers
I chose D because I though her own will is the key to compliance. What's your opinion on this?
Any response will be appreciated. Thanks. Wish everyone well
1-50 A 65-year-old woman is being treated in the hospital for widely metastatic breast cancer unresponsive to chemotherapy. She has never married and has no children or siblings. Throughout her illness, another woman she had introduced as "my close friend," has been with her during hospitalizations and office visits. The patient is moved to an inpatient hospice after she decides she wants no further curative therapy. She and her friend appear very distressed when they read a sign outside the hospice unit that states only family members are permitted to stay after visiting hours. Her friend says, "We can't bear to be apart. It would be cruel to separate us now." Which of the following responses by the physician is most appropriate?
A"Don't worry. I'll call you right away if something happens to your friend. Just leave your number with the nurses."
B"I'm sorry, but only family is allowed to stay with patients in the hospital. You will have to leave after your 15 minutes are up."
C"The two of you seem to have a very important relationship. Of course you may stay together."
D"Visiting hours are posted outside. You are welcome during any of those times. I'm sorry, but an exception cannot be made in your case."
E"Well, I guess we could bend the rules just this time, but if anyone asks, you're her sister. Does that sound OK?"
I chose D. I was thinking that we're to adhere to rule. C seems like exception to be made, along with E. Does D sound too indifferent to patient?
2-30 A 6 week old girl is brought to the physician by her mother because of a 6 day history of vomiting a small amount of milk 2-3 times daily. She appears well. She is at the 50th percentile for length and weight. Physical examination shows no abnormalities. Which of the following is the most likely cause of this patient's findings?
a) Esophageal spasm
b) Gut malrotation
c) Immature lower esophageal sphincter
d) Neuromuscular abnormality of the esophagus
e) Pyloric stenosis
f) Tracheoesophageal fistula
I really didn't get this one.
2-50 A new compound is taken up by bacterial cells. No energy is necessary for uptake, and the compound is not concentrated in the cell. Which of the following best describes this mechanism of transport?
a) ATP mediated active transport
b) Carrier mediated diffusion
c) Group translocation
d) Phosphorylation linked transport
e) Proton gradient mediated transport
3-2 47 year old woman with psoriasis comes for followup. At her last appointment she was given several topical creams, which must be applied in a specified sequence twice a day. No improvement is apparent in the current appointment. What would be the best way to begin the discussion of this patient's compliance with therapy ?
a. Did you use the creams twice daily ?
b. How many tubes did you use in the last month ?
c. How often did you skip treatments ?
d. Most people find it difficult to stick to a routine. How did you do ?
e. Using something twice daily can be difficult. I assume you are like most people who miss at least 10% of treatments.
Was stuck between B and D. Then I thought D seems relatively judgemental, so I chose B , which I thought is a more open ended response.
4-15 6-Mercaptopurine (6-MP) used to treat acute lymphoblastic leukemia (ALL). 6-MP acted on by enzymes to make 6-thioguanine nucleotides (6-TGN). Efficacy and toxicity of 6-MP correlated with 6-TGN. 6-MP acted on by xanthine oxidase (XO), thiopurine methyltransferase (TPMT), leading to inactive metabolites. Which are clinical consequences of ALL patients homozygous for low-activity alleles of TPMT?
A) They must be given normal dose of 6-MP
B)They must be given decreased dose of 6-MP
C)They must be given increased dose of 6-MP
D)They must be given injection w/ XO if treated with 6-MP
Was stuck between B and D. Ended up choosing D and wrong. Was thinking if we decrease dose of 6-MP, wouldn't his therapeutic effect decline? What if we supply him some XO considering that he's deficient of TPMT?
4-16 A physician is sad because he has to inform a patient of progression of carcinoma to terminal phase. When the patient sees the physician's face, he begins to cry and says, "it's bad news, isn't it? Which of the following responses is most appropriate?
A) How have you been since the last time I saw you?
B) Let's talk about the positive aspects first.
C) Look on the bright side of things.
D) Tell me how you are feeling.
E) There are other people who have it a lot worse than you.
F) Yes, it is.
G) You've had several years better off than many others with this disease.
I chose A and wrong. Was stuck between A and D. I found somewhere somebody say it's F, which seemed cold to me. What do you guys think?
4-19 15 yo f with 1 day h/o redness and painful skin following sunbathing. she used sunblock every few hours. P/E shows severe erythem of back and extremities. there are no blisters. Dx?
A)allergic reaction to sun
B)first degree burn
C)rhus dermatitis
D)2nd degree burn
E)3rd degree burn
Just wonder how to distinguish between 1st degree burn and allergic reaction. Should the latter have quicker onset?
4-40 14 year old boy brought into the physician by his mom bcuz of daily headaches for 2 onths. The headaches are described as bilateral aching in the temples. His mom states that he also "has not been himself" for the past few mos. he seems more confused, often forgetting names, dates, and places and he is clumsy with frequent falls. his school performance dropped. P/E shows broadbased, ataxic gait. He is alert and oriented to person place and time but he is slow to answer questions. Chronic abuse of which of the following substances is most likely cause of this patients condition?
a)cocaine
b)ethanol
c)inhaled glue
d)methamphetamies
e)PCP
I chose B because the boy has confusion, ataxia, which lead me to think thiamine deficiency commonly caused by alcoholism. But NBME said I'm wrong. I found that the answer is probably C. I didn't find glue toxicity in First Aid, nor can I understand why answer B should be excluded
4-50 A 15-year-old girl comes to the physician's office for a health maintenance examination Her mother was recently diagnosed with squamous cell carcinoma of the face and her maternal grandfather died of metastatic melanoma. During the visit, the physician advises her about methods of photoprotection including daily use of a sunscreen. In a patient of this age which of the following factors is most likely to predict compliance with photoprotection?
a Ability to tan
b Advice of the physician to wear sunscreen
c Concern about premature aging of skin
d Desire to prevent sunburn
e Family history of skin cancer
f Use of sunscreen by her peers
I chose D because I though her own will is the key to compliance. What's your opinion on this?
Any response will be appreciated. Thanks. Wish everyone well
