Undiscussed questions of NBME 19

[codebluewinniethepooh]

Hello everybody,
I will try my best to discuss the questions that I think are confusing and did not find them discussed in a previous thread, please help me with your explanation. I will do appreciate your comment. I will do my best to avoid copyright violations as well.

1- the question about the man with dementia who is living in a nursing home and recently admitted to the hospital due to swallowing dysfunction. what is the most appropriate way for the physician to address the feeding tube? My answer was is to recommend the feeding tube by mentioning its benefits; however, the right answer was to advise the family to make a decision based on what would have the patient wanted?
Can you please provide your explanation on why the answer I chose is wrong?

2- For the young lady whos sister and other family members had melanoma, what is the lesion that should be expected to present on both sun exposed and non-sun exposed areas? I chose the blue nevus however the answer was the dysplastic one... why is that? this kind of patients usually have both benign and dysplastic nevi, so it should be a common sense that the dysplastic nevus is more prevalent in the sun exposed areas .... what is your explanation?

3- Isn't the chronic gastritis type B (H.pylori) associated with atrophic mucosal changes? why does the nbme question says that the mucosa is thickened nodular with no discrete ulceration in this type of gastritis? P.S. I know that there is increased gastrin and one of its function is stimulate growth of the gastric mucosa, but this is not what FA 2016 P 356 says

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[sahell]

1 - order of priority in medical decisions - subjective judgment, substituted judgment, best interest standard

2 - dysplastic nevus syndrome - CMM1 gene on chromosome 1. I was so unsure of this one.

 

[Mr.Emboli]

Hi everyone, I really need someone to bounce these questions with because I don't have any friends that have taken nbme 19 and I don't want to ruin it for them. Thank you so much in advance!

1. The question about the old woman with 1 day of sudden onset of left leg weakness, with left lower extremity decreased muscle strength and 3+ DTR, can't tell if her left great toe is raised or depressed, with the remainder of the examination showing no abnormalities.

The answer is embolism of the right anterior cerebral artery. But wouldn't a right ACA emobli cause decrease sensation as well? why is it just her proprioception that is affected (knowing if her toe is raised or depressed). I picked a left ASA embolism, even though it didnt fit the picture perfectly, it was going to get me a UMN motor lesion match with a singular proprioceptive match with the vignette. Saying there's no abnormalities other than motor and proprioception leaves me to think that sensation is spared. HELP.

2. 5 y.o boy with a retinal mass, but doctor says he's at no risk for any other neoplasms? I see what they are trying to go for in saying that it is a local mass and not familial Rb is the doctor says there's no increased risk for neoplasms. BUT how in the world does a 5 y.o kid get a Retinoblastoma from just chance mutations. I thought the whole idea was that it was almost impossible to get one sporadicly and usually if you see one early in life, it's because of the 1 hit hypothesis. HELP PLZ.

Thanks!

Mr. Emboli

 

[Reperfused]

Unilateral retinoblastoma means sporadic. You can get it anytime in life. It’s more common in children.

Hereditary retinoblastoma would always be bilateral.

 

[Mr.Emboli]

Unilateral retinoblastoma means sporadic. You can get it anytime in life. It’s more common in children.

Hereditary retinoblastoma would always be bilateral.

Thanks for replying man. That makes sense. Do you know why it's more common in children? In my mind, to get a unilateral retinoblastoma you need to get two hits on the Rb gene and the chances of that happening increases as you get older. Why is there propensity for children to get unilateral Rb over adults?

Also any thoughts on the other question above?

 

[STEPinthenameoflove2018]

I’m not expert but I think for the point of the Retinoblastoma was to make you differentiate between hereditary VS sporadic.
When the question said “there’s no chance of it recurring” it doesn’t matter what kind of cancer it was - the point is that it’s sporadic. Substitute a different body part if that helps. You can’t assume every retinoblastoma is hereditary.




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[STEPinthenameoflove2018]

Regarding the ASA one - I got this one wrong too - the point of this question was not that it was an ASA but it specifically said in the stem that the dorsal column was affected -

By definition a complete ASA “occlusion” spares the DC so this isn’t a true ASA.


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[STEPinthenameoflove2018]

Okay now help me - the aspiration pneumonia X-ray ... why the answer D? I thought it would be C because it affected the right lobe an not the left...

Also I did nbme 19 offline - what was the answer for the Niemann pick question - I thought it was decrease ceramide by my answer key is saying decrease lysosomal hydroxylase...


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