NBME 11 question

[Master Deep]

Can anyone whos done NBME 11 explain how to figure out the serum protein electrophoresis question. 12 yr old boy admitted to hospital because of lethary, hip pain and fever. hes been admitted many times becaues of pneumonia. And then it gives the diff kinds of serum protein electrophoresis.
Thanks!

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[medpack87]

Awesome. Thank you VERY MUCH

 

[Jonari]

what about that question about blood flow to the uterus, i think it is...i've seen that the nbme practice exams i've done, there is always that one or two questions about blood flow through the perineum region. anybody have any good recommendations on how to learn this portion?

i took a quick glance through kaplan anatomy, and unfortunately nothing in there.

 

[medpack87]

what about that question about blood flow to the uterus, i think it is...i've seen that the nbme practice exams i've done, there is always that one or two questions about blood flow through the perineum region. anybody have any good recommendations on how to learn this portion?

i took a quick glance through kaplan anatomy, and unfortunately nothing in there.

Which question? The one that asked what was the quickest way from the femoral artery to the uterine? That one was femoral, external, internal iliac and uterine.

And yes, i think I've also seen at least 1 anatomy question concerning pelvic region on every NBME and SA.

 

[suji0]

for people who took this exam online, do you know about how many you missed to get the score you did (if you don't mind sharing)? I took it offline and missed 21 questions which is about 89%-90% which is a 249/250 according to this pdf thing i found on here, but of course that could be off because of curve and stuff?

 

[medpack87]

for people who took this exam online, do you know about how many you missed to get the score you did (if you don't mind sharing)? I took it offline and missed 21 questions which is about 89%-90% which is a 249/250 according to this pdf thing i found on here, but of course that could be off because of curve and stuff?

I had 35 incorrect. That is 82.5% of correct answers overall, 530 of NBME algorithm score = 228 predicted

 

[Goober11]

for people who took this exam online, do you know about how many you missed to get the score you did (if you don't mind sharing)? I took it offline and missed 21 questions which is about 89%-90% which is a 249/250 according to this pdf thing i found on here, but of course that could be off because of curve and stuff?

I missed 18 (91%) and scored 252. That pdf thing doesn't seem too off, might have given you an extra couple points.

 

[suji0]

I missed 18 (91%) and scored 252. That pdf thing doesn't seem too off, might have given you an extra couple points.

awesome job man, yeah im just subtracting a solid 5 points at least just caus id rather underestimate myself slightly then overestimate and make myself feel better than i should haha

 

[Goober11]

I am embarrassed to say I had A LOT of trouble with the section of the medulla. I also missed a similar question to this in UW. How do you approach this question to know which layer is the glomerulosa?

 

[CaptainSSO]

Seventy nine year old woman with dementia, DMII, and HTN brought in for chest pain and agitation for 4 hours. Smoked 2 packs a day until 70, when she quit. Pulse 120, RR 32, BP 180/100. Crackles are heard in both lung bases, with a systolic ejection murmur at the apex of the heart and regular rhythm. ECG shows ST-elevation in anterolateral leads. Chest X-ray shows mildly enlarged cardiac silhouette.

A. Acute Coronary Syndrom
B. Cerebrovascular Event
C. Acute Pericarditis
D. Bilateral Pneumonia
E. Pulmonary Embolism



Also this one:

Pt. with CHF, progressive chest pain and dyspnea. Bilateral pleural effusions.

Pleural Fluid Serum
Glucose 80 mg/dL 100 mg/dL
LDH 25 50
Protein 2 7
500 nucleated cells/mm^3

Was going to put ^hydrostatic just cause of the CHF, but the pleural fluid analysis through me off.

A. Increased hydrostatic
B. Decrease Oncotic
C. something
D. Increased vascular perm.

Edit: Sorry, my chart sucks, I just put all the pleural effusion values in red. Wondering how exactly to interpret that chart

 

[CaptainSSO]

Anyone?

 

[Goober11]

Seventy nine year old woman with dementia, DMII, and HTN brought in for chest pain and agitation for 4 hours. Smoked 2 packs a day until 70, when she quit. Pulse 120, RR 32, BP 180/100. Crackles are heard in both lung bases, with a systolic ejection murmur at the apex of the heart and regular rhythm. ECG shows ST-elevation in anterolateral leads. Chest X-ray shows mildly enlarged cardiac silhouette.

A. Acute Coronary Syndrom
B. Cerebrovascular Event
C. Acute Pericarditis
D. Bilateral Pneumonia
E. Pulmonary Embolism

The crackles implicate acute heart failure which accompanies a heart attack (or ACS). Also the ST elevation in a discrete location rules out pericarditis and is fairly specific in this case for ACS.


Also this one:

Pt. with CHF, progressive chest pain and dyspnea. Bilateral pleural effusions.

Pleural Fluid Serum
Glucose 80 mg/dL 100 mg/dL
LDH 25 50
Protein 2 7
500 nucleated cells/mm^3

Was going to put ^hydrostatic just cause of the CHF, but the pleural fluid analysis through me off.

A. Increased hydrostatic
B. Decrease Oncotic
C. something
D. Increased vascular perm.

Each of these things in their own right can cause pleural effusion, however, since this patient has CHF they have back pressure building up in their pulmonary venous circuit which increases hydrostatic pressure toward the pleural space.

Hope this helps!

 

[Jonari]

Seventy nine year old woman with dementia, DMII, and HTN brought in for chest pain and agitation for 4 hours. Smoked 2 packs a day until 70, when she quit. Pulse 120, RR 32, BP 180/100. Crackles are heard in both lung bases, with a systolic ejection murmur at the apex of the heart and regular rhythm. ECG shows ST-elevation in anterolateral leads. Chest X-ray shows mildly enlarged cardiac silhouette.

A. Acute Coronary Syndrom
B. Cerebrovascular Event
C. Acute Pericarditis
D. Bilateral Pneumonia
E. Pulmonary Embolism

I'm sure I wrote A for this. Her BP is mad high. obviously she's hypertensive, correct? systemic HTN --> concentric hypertrophy of the heart --> needs more oxygen to meet the oxygen supplyemand. since this isn't met, she had a MI...which caused the STEMI presentation.



Also this one:

Pt. with CHF, progressive chest pain and dyspnea. Bilateral pleural effusions.

Pleural Fluid Serum
Glucose 80 mg/dL 100 mg/dL
LDH 25 50
Protein 2 7
500 nucleated cells/mm^3

Was going to put ^hydrostatic just cause of the CHF, but the pleural fluid analysis through me off.

A. Increased hydrostatic
B. Decrease Oncotic
C. something
D. Increased vascular perm.

Edit: Sorry, my chart sucks, I just put all the pleural effusion values in red. Wondering how exactly to interpret that chart[/QUOTE]

CHF --> activation of the J-receptors in the lungs causes dyspnea, basically choking and can't breathe. Fluid is going into the lungs...because hydrostatic pressure is building up.

 

[Syncity]

The key concept in answering this question is Light's criteria. Light's Criteria helps determine whether the pleural fluid represents a translate or an exudate. It's an exudate if:

(i) Pleural fluid protein: serum protein > 0.5 or
(ii) Pleural fluid LDH: serum LDH > 0.6 or
(iii) Pleural fluid LDH > 2/3 upper limit of normal serum LDH

RECALL: Causes of transudative pleural effusions include heart failure, renal failure, nephrotic syndrome, liver failure, hypothyroidism (remember failure - heart/ kidney/ liver/ thyroid failure. Rarer causes include Meigs' Syndrome). Causes of exudates include infection, inflammation, malignancy and connective tissue diseases.

Did Step 1 three years ago - just stumbled across this thread.

 

[Pinkleton]

Ok I thought this question was ridiculous

(paraphrase) Methotrexate causes inhibition of which of the following enzyme activities?

The answer is thymidylate synthase. I know 5-FU inhibits that enzyme, and that MTX would lower DHF levels...but how is that considered inhibiting the enzyme? I put DNA polymerase, think that with MTX you will have reduced ability to synthesize DNA (the whole point of the drug)

 

[CaptainSSO]

Ok I thought this question was ridiculous

(paraphrase) Methotrexate causes inhibition of which of the following enzyme activities?

The answer is thymidylate synthase. I know 5-FU inhibits that enzyme, and that MTX would lower DHF levels...but how is that considered inhibiting the enzyme? I put DNA polymerase, think that with MTX you will have reduced ability to synthesize DNA (the whole point of the drug)

When the MTX inhibits DHFR, it can't regenerate the THF and can't methylate the dUMP. So it's removing thymidylate synthase's substrate. Try not to think too far ahead for these questions. You need to think of the most proximal effects first. So...DHFR is not an answer choice, what is the immediate closest downstream effect of that...removing the substrate for thymidylate synthase.

 

[Pinkleton]

When the MTX inhibits DHFR, it can't regenerate the THF and can't methylate the dUMP. So it's removing thymidylate synthase's substrate. Try not to think too far ahead for these questions. You need to think of the most proximal effects first. So...DHFR is not an answer choice, what is the immediate closest downstream effect of that...removing the substrate for thymidylate synthase.

Good call. I thought they were trying to make us mixup the MOA of MTX and 5FU. I'm starting to think that UWorld has done me more harm than good. I've missed so many simple NBME questions from over thinking. Does anyone have any advice on how to approach these questions? i.e. keep my thought process as simple as possible for every question?

 

[coolforschool]

Good call. I thought they were trying to make us mixup the MOA of MTX and 5FU. I'm starting to think that UWorld has done me more harm than good. I've missed so many simple NBME questions from over thinking. Does anyone have any advice on how to approach these questions? i.e. keep my thought process as simple as possible for every question?

It's always tough, man. I feel like some of the NBME questions are gimmes, but then other ones really make you look at all of the answer choices and think which one is the best. Also, the wording sometimes gets me too. I don't really know how to approach it either.

 

[doctoritis]

The question about 59 year old man who worked in insulation for 30 years and presented with chest pain, SOB, weight loss over the past 3 months. Biopsy shows "anaplastic biphasic neoplasm that expresses calretinin and cytokeratin but not CEA" and they show you a CXR that looks like an effusion.

A - Birbeck Granules - histiocytosis (no mention of any eosinophilia, so can be eliminated?)

B - Dense Core Secretory Granules = not sure why this answer can be eliminated, would lead me to believe this may mean one of the neurosecretory granule secreting lung cancers

C - Ferruginous Bodies

D - Signet Ring Cells = not really making any sense in the context, can be eliminated

E - Silica (i suppose that should show hilar calcified lymph nodes specifically and not an effusion?, and it's not a precursor to any cancer?)



This question is giving me a little bit of a hard time. It's not that I can't see why C - Ferruginous Bodies are not the right answer, but I'm having a little difficulty 100% eliminating B and E as wrong answer choices.

They tell you he's in insulation, so that certainly sounds like asbestos exposure. Weight loss also makes me believe there is cancer going on, so makes sense that it is has progressed to a mesothelioma. But how can we eliminate B and E with confidence?

 

[medpack87]

hmm... well option B. Dense core secretory granules would be out because as you said, the case here is probably a mesothelioma, and these granules would be seen in small cell lung cancer.

Option E is a good choice, but remember that you have to choose the BEST answer. So out of all of them, the best one is C. Ferruginous bodies which are seen in asbestosis. The chest x ray clearly showed a pleural hyperdensity, so the definite dx would be mesothelioma. Silicolosis would show the calcified lymph nodes.

You just have to make the dx first and then choose the finding that goes best with your dx. Insulation, respiratory symptoms, pleural calcification, all of those should alert you to asbestosis and mesothelioma.

 

[Ursa]

So...I had a huge huge jump from NBME 7 to NBME 11 over the span of only 6 days. Anybody have experience with this? Happy with the jump, but it makes me wonder if it's a fluke or if I just happened to know the selected questions on 11.

 

[coolforschool]

So...I had a huge huge jump from NBME 7 to NBME 11 over the span of only 6 days. Anybody have experience with this? Happy with the jump, but it makes me wonder if it's a fluke or if I just happened to know the selected questions on 11.

My jump was +28 points from NBME 7 to NBME 11 (3 weeks in between). Dropped a bit from 11 to 12. Went +15 from 12 to 13.

 

[medpack87]

Well, if for your next NBME you drop MORE than what you increased, then it was a fluke. If you drop some points, as long as it stays over your base NBME score, I think its ok.

 

[uncgirl501]

Another question:
Which is the first anatomical landmark visualized before reaching Larynx while doing Bronchoscopy:
1. Base of tongue
2. Epiglottis
3. False Vocal cord
4. True vocal cords

What's the answer for this question? I don't remember seeing this on NBME 11. Thanks!

 

[dragon529]

Question regarding 5yo boy w/ asthma, described the symptoms then at the end tells us the lateral CXR shows a wedge-shaped density extending anteriorly and inferiorly from the hilum. A CT scan would most likely show obstruction of which of the following?
a. left main-stem
b. left upper lobe
c. right lower lobe (chose this one...)
d. right main-stem (was this the correct answer? was the object so big that it got stuck here before reaching the lower lobe!?)
e. right middle lobe

 

[coolforschool]

Question regarding 5yo boy w/ asthma, described the symptoms then at the end tells us the lateral CXR shows a wedge-shaped density extending anteriorly and inferiorly from the hilum. A CT scan would most likely show obstruction of which of the following?
a. left main-stem
b. left upper lobe
c. right lower lobe (chose this one...)
d. right main-stem (was this the correct answer? was the object so big that it got stuck here before reaching the lower lobe!?)
e. right middle lobe

Right middle lobe; it's wedge-shaped and extends anteriorly and inferiorly.

 

[dragon529]

Ah... I didn't think of that correlation. =(
Saved this one for last and really nailed me hard poo...

 

[MLT2MT2DO]

Question regarding 5yo boy w/ asthma, described the symptoms then at the end tells us the lateral CXR shows a wedge-shaped density extending anteriorly and inferiorly from the hilum. A CT scan would most likely show obstruction of which of the following?
a. left main-stem
b. left upper lobe
c. right lower lobe (chose this one...)
d. right main-stem (was this the correct answer? was the object so big that it got stuck here before reaching the lower lobe!?)
e. right middle lobe

Right middle lobe; it's wedge-shaped and extends anteriorly and inferiorly.

Also IC space 4-6 was how I arrived at the right answer, though I probably should know anterior/inferior for middle lob as well

 

[coolforschool]

Also IC space 4-6 was how I arrived at the right answer, though I probably should know anterior/inferior for middle lob as well

Haha. Kaplan vids? I zoomed through parts of anatomy a few days ago. It helped a lot.

 

[cpufreak3]

For the question about secretin infusion, anyone know why it's pancreatic bicarb and not hepatic bile secretion? Doesn't secretin stimulate both?

 

[sharklasers]

For the question about secretin infusion, anyone know why it's pancreatic bicarb and not hepatic bile secretion? Doesn't secretin stimulate both?

Maybe secretin stimulates bile secretion from the gallbladder, not liver?

I knew for a fact it was HCO3 so I chose that, but I see your point.

 

[MLT2MT2DO]

For the question about secretin infusion, anyone know why it's pancreatic bicarb and not hepatic bile secretion? Doesn't secretin stimulate both?

Secretin is more known for its HCO3 affect. It also "washes" down the bile that is in the ducts and that's why there's an increase in bile with secretin as well.
I've always imagined that CCK stimulates gallbladder which releases bile, then secretin comes along and cleans up the junk left behind. If you had just a secretin infusion I don't know how much bile would actually increase.

This was definitely a "choose the best answer" question, though.

 

[sharklasers]

What is that question with a 30y/o woman who clearly has a history of IV drug use and has small nodules in perihilar lung fields

I put granulomatous inflammation but it was just a guess

 

[sharklasers]

Also, I didn't really see a good answer to this, can someone explain how prednisone can cause decreased bone formation due to inhibition of osteoblast differentiation? The "differentiation" part confused me the most, I didn't really understand what this meant. I thought I remembered prednisone decreasing calcium absorption, so I figured PTH would then increase bone resoprtion as a response... this was wrong.

 

[donaldduck]

What is that question with a 30y/o woman who clearly has a history of IV drug use and has small nodules in perihilar lung fields

I put granulomatous inflammation but it was just a guess

Yeah it was granulomatous inflammation. That was the only choice that would show up as nodules in an x-ray... i was tempted to pick neutrophilic abscess but that wouldnt show up as a nodule it would be described as a air-fluid line. Also in the question stem it said that biopsy from these regions will most likely "show foreign particles surrounded by..." Whenever i see foreign particles in the lung i think about granulomatous inflammation.
Hope this helps

 

[sharklasers]

What were the foreign particles though??

 

[eagles22]

What were the foreign particles though??

Talc apparently. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2561715/?page=2

 

[Gryhu]

Haven't posted in a while but, since I took this yesterday, I figured I'd contribute to the pyloric stenosis question. I had no idea how to answer this question when I was actually taking the exam. Decided to watch Kaplan Med Genetics (since its my weakest section) and I feel like I have a pretty good understanding as to why A is the answer.

Ok, we all know that its pyloric stenosis and that pyloric stenosis is multifactorial but its more common in males (hence the lower threshold). Now, if the newborn was a male then his brother would have the same risk and his sister would have a lower risk - normal stuff, right?

BUT if the newborn was a female (with a higher threshold) that means that this family has a lot of pretty "bad genes" to have it appear in a female. So that means, its going to be much easier (higher risk) for her brother to have it.

I personally didn't understand the previously posted explanation so I hope this helps anyone that was as confused as I was.

 

[MLT2MT2DO]

Also, I didn't really see a good answer to this, can someone explain how prednisone can cause decreased bone formation due to inhibition of osteoblast differentiation? The "differentiation" part confused me the most, I didn't really understand what this meant. I thought I remembered prednisone decreasing calcium absorption, so I figured PTH would then increase bone resoprtion as a response... this was wrong.

Prenisone induces apoptosis in cells, and why it is even used as a chemo agent in some cancers. I simply didn't try to over think it...osteoblasts undergo apoptosis, they aren't differentiating.

 

[CaliAtenza]

Secretin is more known for its HCO3 affect. It also "washes" down the bile that is in the ducts and that's why there's an increase in bile with secretin as well.
I've always imagined that CCK stimulates gallbladder which releases bile, then secretin comes along and cleans up the junk left behind. If you had just a secretin infusion I don't know how much bile would actually increase.

This was definitely a "choose the best answer" question, though.

i got tripped up on this question as well. FA has it though, that Secretin is more important for HCO3. The question about Neutrophil chemotaxis and oxidative metabolism being defective due to an increase of a certain enzyme....i got it wrong. I put myeloperoxidase as having increased activity, but i am not sure what the answer is. The answer choices were: A. Adenlyl Cyclase, B. Myeloperoixdase (wrong), C. NADPH Oxidase, D. Phosolipase C and E. Protein Kinase E.

 

[cpufreak3]

That's pertussis toxin which increases adenylyl cyclase

 

[CaliAtenza]

That's pertussis toxin which increases adenylyl cyclase

ah okay , thanks! Yeah i knew it was pertussis toxin but i couldnt remember what it increased...

 

[Pamplemousse123]

Hi everyone, I have few questions about some concepts:

1. Mean = median in an experiment. What measure is used to analyze "dispersion"
a. coefficient of variation
b. interquantile range
c. percentile
d. range
e. standard deviation

I am not really sure why isn't it B, although I knew E was a good answer. When do you use B anyway? Is it when mean does not equal to median?

2.60-year-old with 6-month history of decreased libido and inability to sustain an erection.Decreased energy, has been falling asleep by 7 pm each evening. No psych issues. 1 in loss in height. 3 in inc in waist. Physical examination shows mild gynecomastia and decreased muscle mass throughout. Which of the following is the most appropriate pharmacotherapy for this patient?

A )Epoetin alfa

B) Human growth hormone

C) Modafinil

D) Sildenafil

E) Testosterone

Hmm, isn't this normal old age with a decreased testosterone? Aren't there adverse effects with testosterone such as advancing prostatic adenocarcinoma? Ya, I know the stem didn't say, but it should still be considered... I eliminated all, then chose sildenafil, then chose testosterone due to his laundry list of complaints with decreased testosterone..


3) Pt treated with a standard dose of ceftriaxone. The symptoms disappear in 2 days but a mucoid discharge appears 10 days after treatment. Why did sx reappear

Is it because CTrach sx appear later (around 10d) than gonn? I remember reading this but I wish to confirm.

4) The O2/kiney question:

A Counter-current multiplication in the kidneys allows them to use less oxygen for ion transport than other organs

--- Is this even true? I realize its not the best answer..


5) The pneumothorax question: For those of you with the x ray, isn't the trachea deviated away from the lesion? but the question stem made it seem like a spontaneous pneumothorax rather than a tension, can someone please explain?

6) "An intravenous bolus of gonadotropin-releasing hormone induces a marked increase in serum luteinizing hormone concentration 1 hour later." So this is clearly central precocious puberty. I coudln't understand though if it were hyperGnRH or hyperLH causing precocious puberty. Can someone explain how this bolus procedure works?


7) A female newborn dies at the age of 12. (Picture of brain at autopsy is shown). The newborn was most likely affected by which of the following?

-hyperbilirubinemia
-hypoxia/ischemia
So the brain was indeed yellow, but wasn't the brain chipped off at the watershed region of ACA-MCA? I realize yes, it occurs more frequently in the elderly, but why on earth was the brain chipped off?


8) The melanoma with regression question:

a. Antibody dependent cellular rxn
b. Antibody mediated cellular dysfunction
T lymphocyte mediated cytotoxicity

I was trying to find NK cell function in the answer choices..but I couldn't tell what the difference was between A/B and if either one of them represented NK Cell. Is it correct that NK cells are also responsible for cancer regression? Do cytotoxic T cells have more of a role than NK cells in this process?


Thanks in advance!

 

[Oreoomar]

I haven't been able to find anyone answer this yet...can someone explain the difference between acities, transudate, and exudate please?

17 year old boy in the ER from high grade fever and ab pain that started 2 days ago, resolved without medication but then reoccurred 3 hours ago - shows guarding and tenderness - Fluid is found to have a specific gravity of greater than 1.020, numerous leukocytes (segmented neutrophils), and cellular debris

Transudate, Exudate, Ascities, Lymphedema, or Blood?

 

[Jamiu22]

I haven't been able to find anyone answer this yet...can someone explain the difference between acities, transudate, and exudate please?

17 year old boy in the ER from high grade fever and ab pain that started 2 days ago, resolved without medication but then reoccurred 3 hours ago - shows guarding and tenderness - Fluid is found to have a specific gravity of greater than 1.020, numerous leukocytes (segmented neutrophils), and cellular debris

Transudate, Exudate, Ascities, Lymphedema, or Blood?

I believe that its an exudate...since they talked about it having celllular debris and increased specific gravity.

 

[Oreoomar]

Hi everyone, I have few questions about some concepts:

1. Mean = median in an experiment. What measure is used to analyze "dispersion"
a. coefficient of variation
b. interquantile range
c. percentile
d. range
e. standard deviation

I am not really sure why isn't it B, although I knew E was a good answer. When do you use B anyway? Is it when mean does not equal to median?
I think quartiles are a measure of median, not mean

2.60-year-old with 6-month history of decreased libido and inability to sustain an erection.Decreased energy, has been falling asleep by 7 pm each evening. No psych issues. 1 in loss in height. 3 in inc in waist. Physical examination shows mild gynecomastia and decreased muscle mass throughout. Which of the following is the most appropriate pharmacotherapy for this patient?

A )Epoetin alfa

B) Human growth hormone

C) Modafinil

D) Sildenafil

E) Testosterone

Hmm, isn't this normal old age with a decreased testosterone? Aren't there adverse effects with testosterone such as advancing prostatic adenocarcinoma? Ya, I know the stem didn't say, but it should still be considered... I eliminated all, then chose sildenafil, then chose testosterone due to his laundry list of complaints with decreased testosterone..
Testosterone was correct

3) Pt treated with a standard dose of ceftriaxone. The symptoms disappear in 2 days but a mucoid discharge appears 10 days after treatment. Why did sx reappear

Is it because CTrach sx appear later (around 10d) than gonn? I remember reading this but I wish to confirm.Yep

4) The O2/kiney question:

A Counter-current multiplication in the kidneys allows them to use less oxygen for ion transport than other organs

--- Is this even true? I realize its not the best answer..
I don't think so


5) The pneumothorax question: For those of you with the x ray, isn't the trachea deviated away from the lesion? but the question stem made it seem like a spontaneous pneumothorax rather than a tension, can someone please explain?
I just know its a tension pneumothorax, I'm not really sure based on the clinical vingette

6) "An intravenous bolus of gonadotropin-releasing hormone induces a marked increase in serum luteinizing hormone concentration 1 hour later." So this is clearly central precocious puberty. I coudln't understand though if it were hyperGnRH or hyperLH causing precocious puberty. Can someone explain how this bolus procedure works?
I think its something like if theres a greater than 2 fold increase of LH with administration of GnRH its considered precocious puberty that can be treated with non-pulsitile GnRH

7) A female newborn dies at the age of 12. (Picture of brain at autopsy is shown). The newborn was most likely affected by which of the following?

-hyperbilirubinemia
-hypoxia/ischemia
So the brain was indeed yellow, but wasn't the brain chipped off at the watershed region of ACA-MCA? I realize yes, it occurs more frequently in the elderly, but why on earth was the brain chipped off?
I put hypoxia for that same reason, the watershed regions looked messed up so I just didn't pay attention to the fact that it was yellow. Maybe artifact or postmortem?

8) The melanoma with regression question:

a. Antibody dependent cellular rxn
b. Antibody mediated cellular dysfunction
T lymphocyte mediated cytotoxicity

I was trying to find NK cell function in the answer choices..but I couldn't tell what the difference was between A/B and if either one of them represented NK Cell. Is it correct that NK cells are also responsible for cancer regression? Do cytotoxic T cells have more of a role than NK cells in this process?
I dont know which one would be more helpful, but I know CD8 T cells definitely kill cancer cells and that was the only option available

Thanks in advance!

good luck!

 

[GTP]

hi everyone.

Ive been on this forum for over an hour and people dont seem to be discussing the questions I got wrong lol. Can someone please help me out with these questions? I apologize if they are repeat questions and I didn't see where they were discussed. The correct answers or simply directing me to the page number where the question was discussed would be greatly appreciated!!

Thanks !

1. A 5 year old man is brought to ER after left sided weakness. He has weakness in lower 2/3 of face on left, marked weakness of left upper extemity and moderate weakness of left lower extremity. Deep tendon reflxes are more hyperactive in upper extremity, but its hyperactive in both upper and lower extremities on the left. What is occluded?

It was just a brain image with a whole bunch of things labelled. I had a lot of problems with this question because it included symptoms from MCA occlusion and ACA occlusion, so I thought internal capsule?

I've posted a picture of it below. its labeled circle of willis

2. A 40 year old man with alcoholism is admited cuz of 2 day history of confusion. Sodium is 99 meq/l. he is treated with 0.9% saline. Four days later, he has slurred speech. Weakness everywhere. Sensation is fine. Babinski is present bilateral. Where is the lesion?

A Bilateral cerebral hemisphere
B braintem
C medial diencephalon
D Muscle
E NMJ
F Peripheral nerve

I was looking for pons or mid brain but it wasnt there. Thoughts?


3. A full term 1 day old male undergoes hearing exam. No abnormalities Results of otoacoustic emission testing is abnormal. A subsequent diagnostic brainstem auditory evoked response is also abnormal. What is the most compelling eason for this screening program?

A although congenital hearing loss occurs infrequently, cteening is cost effective
B early diagnosis and tx of hearing loss will prevent delay in motor development
C Identification and tx of hearing loss before 6 mo age will allow better prognosis
D newborn screening allows for more time to prepare hearing aids so the baby can be fitted with them when he or she reaches 1 yr of age
E new born screening will identify those children who will require cochlear implant after age 5

?? i hate behavioural science. I picked B and it was wrong.


4. A previously healthy 71 yr old man comes to physican cuz of 1 day history of leg and calf tenderness. Doppler shows DVT. They start heparin now. What is the MOA of the drug that needs to be used for the next 6 mon?

A Binds to the active site on the thrombin molecule
B interferes with the carboxylation of coag factors
C Irrev inactivates COX
D Potentitates anthrombin III
E Selectively inhibits Xa

The answer better not be B. I thought that was for a fib. I picked E (exoxaparin) and it was wrong

5. There is a question about a pedigree. They were talking about CF.



A. AD with variable expression
B AD with variable penetrance
C AR with high heterozygote freq
D AR with low heterozygote freq
E X linked rare gene

Can someone explain this? I picked D (AR with low heterozygote frequency but was wrong). The pedigree is in an image below

Thank you very much in advance!!

edit: I removed the attachments cuz i dont wanna get in trouble with sdn.

 

[startswithb]

hi everyone.

Ive been on this forum for over an hour and people dont seem to be discussing the questions I got wrong lol. Can someone please help me out with these questions? I apologize if they are repeat questions and I didn't see where they were discussed. The correct answers or simply directing me to the page number where the question was discussed would be greatly appreciated!!

Thanks !

1. A 5 year old man is brought to ER after left sided weakness. He has weakness in lower 2/3 of face on left, marked weakness of left upper extemity and moderate weakness of left lower extremity. Deep tendon reflxes are more hyperactive in upper extremity, but its hyperactive in both upper and lower extremities on the left. What is occluded?

It was just a brain image with a whole bunch of things labelled. I had a lot of problems with this question because it included symptoms from MCA occlusion and ACA occlusion, so I thought internal capsule?

I've posted a picture of it below. its labeled circle of willis
It's MCA
2. A 40 year old man with alcoholism is admited cuz of 2 day history of confusion. Sodium is 99 meq/l. he is treated with 0.9% saline. Four days later, he has slurred speech. Weakness everywhere. Sensation is fine. Babinski is present bilateral. Where is the lesion?

A Bilateral cerebral hemisphere
B braintem
C medial diencephalon
D Muscle
E NMJ
F Peripheral nerve

I was looking for pons or mid brain but it wasnt there. Thoughts?
Pons is part of the brainstem.


3. A full term 1 day old male undergoes hearing exam. No abnormalities Results of otoacoustic emission testing is abnormal. A subsequent diagnostic brainstem auditory evoked response is also abnormal. What is the most compelling eason for this screening program?

A although congenital hearing loss occurs infrequently, cteening is cost effective
B early diagnosis and tx of hearing loss will prevent delay in motor development
C Identification and tx of hearing loss before 6 mo age will allow better prognosis
D newborn screening allows for more time to prepare hearing aids so the baby can be fitted with them when he or she reaches 1 yr of age
E new born screening will identify those children who will require cochlear implant after age 5

?? i hate behavioural science. I picked B and it was wrong.

This one had to do with improving language or social development I believe.
4. A previously healthy 71 yr old man comes to physican cuz of 1 day history of leg and calf tenderness. Doppler shows DVT. They start heparin now. What is the MOA of the drug that needs to be used for the next 6 mon?

A Binds to the active site on the thrombin molecule
B interferes with the carboxylation of coag factors
C Irrev inactivates COX
D Potentitates anthrombin III
E Selectively inhibits Xa

The answer better not be B. I thought that was for a fib. I picked E (exoxaparin) and it was wrong
It's B. Long term coag is warfarin. Standard therapy for DVT is heparin to break up the clot then warfarin for 6 months to prevent recurrence.
5. There is a question about a pedigree. They were talking about CF.



A. AD with variable expression
B AD with variable penetrance
C AR with high heterozygote freq
D AR with low heterozygote freq
E X linked rare gene

Can someone explain this? I picked D (AR with low heterozygote frequency but was wrong). The pedigree is in an image below
It's AR with a high heterozygote frequency. This is just something the memorize basically (although pedigree does show a lot of people with disease, more than a typical AR would have.) CF being common is what they are getting at.

Thank you very much in advance!!

Hope that helps!

 

[GTP]

Hope that helps!

Thank you! For the MCA question, how do we account for the lower extremity and upper extremity deficits? Also, for the behavioral question, you answered "This one had to do with improving language or social development I believe". So are you saying the answer is C Identification and tx of hearing loss before 6 mo age will allow better prognosis?

Thanks again

 

[VCorp]

Thank you! For the MCA question, how do we account for the lower extremity and upper extremity deficits? Also, for the behavioral question, you answered "This one had to do with improving language or social development I believe". So are you saying the answer is C Identification and tx of hearing loss before 6 mo age will allow better prognosis?

Thanks again

With the brain question, it also includes facial manifestations, so MCA would be the better option.

 

[GTP]

With the brain question, it also includes facial manifestations, so MCA would be the better option.

thanks!