What is the trickiest question you ever come across in USMLE?

[seasurfer]

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What is the trickiest question you ever come across in USMLE?

 

[HiddenTruth]

Ampicillin and Chlorophenical are both p450 inducers (but not as famous as barbiturates or grisefuvlin).
QUOTE]

By the way, if you are referring to chloramphenicol, (which i think you are b/c i have never heard of chlorophenical), that is actually an INHIBITOR of p450, and not an inducer.

 

[Pox in a box]

i took the same cbse--and i don't remember specifically about the side effect, but i vaguely remember this question. And, somehow, i want to say that it was an ocular side effect, and i think ethambutol was the answer. It was either associated with that, or it may have been a drug itneraction typa' question--i don't quite remember, sorry---does this sound familiar though?

You're dead on, HT. Ethambutol can cause ocular toxicity (decreased vision, loss of red/green color, etc.). Just out of curiosity, was the patient a heavy drinker? Ethambutol also causes hyperuricemia and if the patient was a boozer, acute gout would be a clear precaution.

 

[tigress]

sorry to post where I don't belong but what is the CBSE? I looked it up on google and found something about India

 

[Long Dong]

sorry to post where I don't belong but what is the CBSE? I looked it up on google and found something about India

It is the National Board of Medical Examiners (NBME) Comprehensive Basic Science Examination (CBSE). It was given to us at the end of our second year to see where we stand. They said if you took Step I at that time the score on CBSE is what we would've gotten on step 1. They also said most people improve about 20 points after studying.

 

[Long Dong]

You picked the right choice, my friend. Good Job.

Sonic hedge hog gene expression is responsible for sending a signal from the distal end of a growing bud or lung sac back to the original mesenchyme. If this gene is knocked out (as was shown in knockout mice for this gene), a lung/limb does not differentiate to the normal lung or limb development. This implies that differentiation requires a feedforward signal from the distal end of a growing bud to continue normal development.

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Guys, this is further proof, that NBME is cracking down on molecular biology.

Hey I didn't even see that post cause the last time I looked at the thread it was on page 3. Thanks chandler, no wonder you scored 750 on the NBME, that score is off the hook.

 

[omarsaleh66]

Here is a quesiton I got today on teh path NBME.

What is the leading cause of mortality of late onset in burn patients?

shock
fluid loss
GI ulcers (I think Curling ulcers)
Infection
and I dont remember the other choices.

 

[Pox in a box]

Here is a quesiton I got today on teh path NBME.

What is the leading cause of mortality of late onset in burn patients?

shock
fluid loss
GI ulcers (I think Curling ulcers)
Infection
and I dont remember the other choices.

Pseduomonas infection for late, fluid loss for acute.

 

[omarsaleh66]

I put acute fluid loss but then at the last minute I changed to infection. Do u feel something between us? Cuz i felt it. 😍

EDIT: this is assuming u are a girl.

Double Edit: And Im assuming u are super hot.

Cyberpimpin on the internet is the way to go by the way

 

[MedicineBird]

I got the same picture of a kidney three times on my USMLE...in three different blocks!! By the time I saw the third one, I was so pissed about my previous two answers that I wanted to change them (of course I couldnt). Im sure it made the third question (which was the trickiest) that much harder.

On the surface, the question probably wouldnt have been that hard.

Also, I got a question about: "Which of the following would be most likely to cause a woman on OCP's to get pregnant", and 5 antibiotics were listed, NOT rifampin. At least two are known for killing gut flora (flagyl and clinda). I picked flagyl, but I still dont know which one was MOST likely.

YOU ARE ALL WRONG!!!!! ABs don't get women pregnant, you sillies!!! Sperm do!!!! It was a trick question and you all fell for it! And you call yourselves aspiring physicians!!

 

[automaton]

the answer to the burn question might be GI problems. i read somewhere, i think in rapid review path, that people who have burn have some sort of weird stress induced stomach problem. it can bleed and people can die.

edit: nevermind, that curling ulcer does happen but the leading cause of death is sepsis via pseudomonas.

 

[HiddenTruth]

does the usmle test facts like, "most common", or "leading cause", etc.?

 

[Pox in a box]

I put acute fluid loss but then at the last minute I changed to infection. Do u feel something between us? Cuz i felt it. 😍

EDIT: this is assuming u are a girl.

Double Edit: And Im assuming u are super hot.

Cyberpimpin on the internet is the way to go by the way

Huh?

 

[omarsaleh66]

Huh?

huh? Nothign I was tryign to be a comedian, I guess i need to stick to First Aid.

whatever,
here's another one, what a guy undergoes radiation, what do u see 1 week later?

is it decreased lymphocytes or giant platelets.


any thoughts

Hidden truth, another q i got was whats teh most common Urinary tract infection - E Coli from the micro NBME

2 more q i got yesterday was kinda like what u are asking too.

Japanese woman immigrates to USA and has cancer, what is it? - I put stomach

Whats the most common metasis to the liver - colon

later

 

[Row Jimmy]

Whats the most common metasis to the liver - colon

later

I am pretty sure Lung Cancer is the MC cancer in both Liver and Brain AND Breast cancer is the most common cancer in Lung. I think breast cancer is the MC cancer in Bone as well.

I am not sure where I remember it from, but I recall being surprised. It may be from Goljan's most commons.

RJ

 

[Pox in a box]

I am pretty sure Lung Cancer is the MC cancer in both Liver and Brain AND Breast cancer is the most common cancer in Lung. I think breast cancer is the MC cancer in Bone as well.

I am not sure where I remember it from, but I recall being surprised. It may be from Goljan's most commons.

RJ

I believe it's colon metastasis to liver too.

 

[omores]

Another CBSE question, some kid had some limb malformations,and rib cage malformations, don't remember all the choices, but guessed between hox (homo box) and hedge hog gene. Choose hedge hog, did a goole on hedge hog and still not sure what this gene does.

Sonic hedge hog gene expression is responsible for sending a signal from the distal end of a growing bud or lung sac back to the original mesenchyme. If this gene is knocked out (as was shown in knockout mice for this gene), a lung/limb does not differentiate to the normal lung or limb development. This implies that differentiation requires a feedforward signal from the distal end of a growing bud to continue normal development.

It's clear from your elegant desription of the role of shh that you know far more about the subject than I do. However...

I assume you're implying that the lung malformation would result in rib problems. But I was recently reading about hox genes, which are also well-known to cause limb malformations. Hox 10 and 11 knockout mice were shown by Capecchi et al to have rib anomalies.

Even without knowing that, I probably would have gone with HOX despite my lack of specialized knowledge about either gene family. Why? Because shh is most famous (at least in medical school curricula!) for its role in inducing ventralization of the neural tube. Knee-jerk association: holoprosencephaly. Whereas the many HOX genes, as I learned them, play multiple roles in development that can't be easily summed up. Knee-jerk association: multiple congenital anomalies.

Granted, that approach completely ignores the many roles played by HOX and SHH, and totally lacks subtlety and nuance. But I'm finding that when it comes to practice questions, the less nuance I try to incorporate in my thought process, the better.

 

[Pox in a box]

Bumping for the NKOTB.

 

[RetroMan]

Which of the following palindromes is the one for HindIII restriction enzyme? Probably as random and nit picky as you can get.

 

[p53]

huh? Nothign I was tryign to be a comedian, I guess i need to stick to First Aid.

Huh?

I put acute fluid loss but then at the last minute I changed to infection. Do u feel something between us? Cuz i felt it. 😍

EDIT: this is assuming u are a girl.

Double Edit: And Im assuming u are super hot.

Cyberpimpin on the internet is the way to go by the way

Unbelieveable!

Can you two lovebirds play footsies somewhere else like in a private chat room.

 

[omarsaleh66]

Unbelieveable!

Can you two lovebirds play footsies somewhere else like in a private chat room.

LOL, My online game is weak, thats why Im getting an arranged marriage. And if i dont score a 230, my fiance will leave me for an interventional radiologist,talk about pressure!!

holler

 

[omarsaleh66]

I am pretty sure Lung Cancer is the MC cancer in both Liver and Brain AND Breast cancer is the most common cancer in Lung. I think breast cancer is the MC cancer in Bone as well.

I am not sure where I remember it from, but I recall being surprised. It may be from Goljan's most commons.

RJ

Hey I heard this on goljan the other day. Goljan says lung, another book (cant remember which says colon. Its unfair.

 

[Pox in a box]

LOL, My online game is weak, thats why Im getting an arranged marriage. And if i dont score a 230, my fiance will leave me for an interventional radiologist,talk about pressure!!

holler

p53 has no gender. p53 is a unitool.

 

[brendang]

Idiopathic, was ampicillin, griseofulvin, or chlorphenicol one of the choices? All of these antibiotics rev up the P450 like Rifampin hence increase metabolism of OCP.

thanks nerd.

 

[dotty]

A athletic woman comes in complaining of amenorrhea (I would not complain personally). She is noted to have bilateral galactorrhea on physical exam. MRI with gadolinium shows no abnormalities. What is the diagnosis:

a) Prolactinoma
b) Hypothalamic dysfunction
c) ovarian failure
d ?forgot

I selected 'b' - maybe she's on roids??
\

What a ****in stupid question!!! THis one just pissed me off for days! stupid freaking normal MRI? with gadolinium? how dare they!!!

 

[dotty]

My gosh I took this test months ago and I still remember that one question...

I know there are case reports of prolactinomas not showing up on MRI, but would they test that? What else causes galactorrhea?

 

[Arnold Chiari]

A athletic woman comes in complaining of amenorrhea (I would not complain personally). She is noted to have bilateral galactorrhea on physical exam. MRI with gadolinium shows no abnormalities. What is the diagnosis:

a) Prolactinoma
b) Hypothalamic dysfunction
c) ovarian failure
d ?forgot

I selected 'b' - maybe she's on roids??
\

What a ****in stupid question!!! THis one just pissed me off for days! stupid freaking normal MRI? with gadolinium? how dare they!!!

If the dopaminergic inhibition of the hypothalamus on the pituitary is removed you would have elevated prolactin without having a prolactinoma. B...makes the best sense.

 

[xaelia]

If the dopaminergic inhibition of the hypothalamus on the pituitary is removed you would have elevated prolactin without having a prolactinoma. B...makes the best sense.

That is definitely an annoying question - but, yep, if there's nothing wrong with the pituitary, you have to pick the next best option. But we'll never know for sure what was going through the exam-writer's mind....

My most absurd-looking question involved 2,3,4,5-dienedodecamoyl acidemia or something like that, and I had to choose between eight different enzymes from the small-print of the diagrams for long-chain, medium-chain, and short-chain fatty acid beta-oxidation in my Biochemistry textbook. The force, however, was with me that day....

 

[Arnold Chiari]

Patient has long standing history of Rheumathoid arthritis, taking corticosteroids and NSAIDs for it; what kind of cardiac complications may arise in this setting.

a) constrictive pericarditis
b) dilated cardiomyopathy
c) hypersensitivity myocarditis
d) hypertrophic cardiomyopathy
e) restrictive cardiomyopathy

 

[4424]

A athletic woman comes in complaining of amenorrhea (I would not complain personally). She is noted to have bilateral galactorrhea on physical exam. MRI with gadolinium shows no abnormalities. What is the diagnosis:

a) Prolactinoma
b) Hypothalamic dysfunction
c) ovarian failure
d ?forgot

I selected 'b' - maybe she's on roids??
\

What a ****in stupid question!!! THis one just pissed me off for days! stupid freaking normal MRI? with gadolinium? how dare they!!!

sorry for a stupid response...but i thought many pituitary adenomas do not show up on MRI? or is that true without contrast?

 

[HiddenTruth]

Patient has long standing history of Rheumathoid arthritis, taking corticosteroids and NSAIDs for it; what kind of cardiac complications may arise in this setting.

a) constrictive pericarditis
b) dilated cardiomyopathy
c) hypersensitivity myocarditis
d) hypertrophic cardiomyopathy
e) restrictive cardiomyopathy

I would have to go with E. I was looking for tamponade or pericardial effusion, but beyond that, I think the reactive amyloidosis in RA over long periods of time can result in an acquired cause of restrictive cardiomyopathy. I can't seem to recall any of those cardiac complications with those drugs you mentioned. The drugs are probably there to stump you--by the way, do they do this a lot, where they'll have drugs in the q. stem but the q. has nothing to do with the drugs?--that's messed up!

 

[idq1i]

I would have to go with E. I was looking for tamponade or pericardial effusion, but beyond that, I think the reactive amyloidosis in RA over long periods of time can result in an acquired cause of restrictive cardiomyopathy. I can't seem to recall any of those cardiac complications with those drugs you mentioned. The drugs are probably there to stump you--by the way, do they do this a lot, where they'll have drugs in the q. stem but the q. has nothing to do with the drugs?--that's messed up!

That's a qbank question, btw. Not from Step 1.

While the answer they were looking for is E, dilated cmp is also a distinct possibility

 

[guarana]

I would have to go with E. I was looking for tamponade or pericardial effusion, but beyond that, I think the reactive amyloidosis in RA over long periods of time can result in an acquired cause of restrictive cardiomyopathy. I can't seem to recall any of those cardiac complications with those drugs you mentioned. The drugs are probably there to stump you--by the way, do they do this a lot, where they'll have drugs in the q. stem but the q. has nothing to do with the drugs?--that's messed up!

can't RA also cause constrictive pericarditis?
seems like a crap shoot b/w that and amyloidosis if you ask me!

 

[Arnold Chiari]

That's a qbank question, btw. Not from Step 1.

While the answer they were looking for is E, dilated cmp is also a distinct possibility

yea, it is from q-bank, i just got it wrong and was frustrated

 

[idq1i]

yea, it is from q-bank, i just got it wrong and was frustrated

I was ticked off too. I learned that restrictive, constrictive and dilated cmp were all possible with RA.

 

[JAMMAN]

The heart is part of the:

(A) Pumonary System
(B) Digestive System
(C) Circulatory System
(D) Endocrine System
(E) None of the above.

 

[idq1i]

The heart is part of the:

(A) Pumonary System
(B) Digestive System
(C) Circulatory System
(D) Endocrine System
(E) None of the above.

A - it's in series with the lung
B - it does digest nutrients (eg fatty acids, glycogen)
C - Duh
D - ANP, anyone?

 

[p53]

Patient has long standing history of Rheumathoid arthritis, taking corticosteroids and NSAIDs for it; what kind of cardiac complications may arise in this setting.

a) constrictive pericarditis
b) dilated cardiomyopathy
c) hypersensitivity myocarditis
d) hypertrophic cardiomyopathy
e) restrictive cardiomyopathy

This question was from Qbank. Are you having a hydrocephalus or something?

READ THE TITLE OF THIS THREAD, and then READ THE TITLE OF ONE OF THE STICKY THREADS.

Now beat it.

 

[Bounty]

My gosh I took this test months ago and I still remember that one question...

I know there are case reports of prolactinomas not showing up on MRI, but would they test that? What else causes galactorrhea?

i just read that cimetidine can case galactorrhea via enhanced prolactin secretion...was that an option?

 

[HiddenTruth]

Now beat it.

Do you really think you're the guardian of SDN?

 

[Pox in a box]

I am pretty sure Lung Cancer is the MC cancer in both Liver and Brain AND Breast cancer is the most common cancer in Lung. I think breast cancer is the MC cancer in Bone as well.

I am not sure where I remember it from, but I recall being surprised. It may be from Goljan's most commons.

RJ

I'm so glad I challenged what Goljan told me and looked this up for myself. In my Radiology Review Manual, they agreed with First Aid. Liver's primary is most likely from the colon and least likely from the lung...that saved me BIG TIME. Sometimes G-money makes some mistakes but he's way over the bar compared to under...

 

[grandeelmd]

I'm so glad I challenged what Goljan told me and looked this up for myself. In my Radiology Review Manual, they agreed with First Aid. Liver's primary is most likely from the colon and least likely from the lung...that saved me BIG TIME. Sometimes G-money makes some mistakes but he's way over the bar compared to under...

Path lecturer at my school said most mets to the liver are from lung, not colon...I don't remember exactly why, it may have had something to do with lung cancer being more common than colon cancer...

 

[Scat]

Idiopathic, was ampicillin, griseofulvin, or chlorphenicol one of the choices? All of these antibiotics rev up the P450 like Rifampin hence increase metabolism of OCP.

I came across this post while searching the net for information on ampicillin and any evidence it induces P450. What is your source for this info ?

 

[Arnold Chiari]

This question was from Qbank. Are you having a hydrocephalus or something?

READ THE TITLE OF THIS THREAD, and then READ THE TITLE OF ONE OF THE STICKY THREADS.

Now beat it.

This doesn't quite sound like antisocial personality to me, not paranoid either, maybe a little borderline. Any suggestions for what mental pathology may have inspired this outlash?

 

[p53]

This doesn't quite sound like antisocial personality to me, not paranoid either, maybe a little borderline. Any suggestions for what mental pathology may have inspired this outlash?

Intellectualization....nice.....defense mechanism. I bet the exam is coming up soon.

 

[flash DKG yoo]

This doesn't quite sound like antisocial personality to me, not paranoid either, maybe a little borderline. Any suggestions for what mental pathology may have inspired this outlash?

My guess is that p53 is suffering an ego dystonic homosexuality crisis.