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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[notcuttingit]

I thought 11 was much easier than 7. I think it just goes to show that a lot of it has to do with your particular strengths and weaknesses.

Here's a question: this woman comes in with all the typical symptoms of hypothyroidism, but she also has symptoms of hypocalcemia. So the answer must have been hypothyroidism, but why would she have the additional hypoparathyroid symptoms?

 

[sanhin2]

hy guys before i say anything i would like to thank all you guys for all your input it has really helped me !

1) In the question where it asks to identify which valve is one replaced on the two xrays? whats the answer? Its not mitral.

2) 80 YO women with h/o DM2, HTN, Dementia and smoking came with agitation and chest pain. bp-180/100, RR-32, P-120. Bilat crakles heard on ausc. ejection systolic mumur at apex. ECG:- ST elevation of anterolat leads.

Is is cerebrovascular accident?

3) 50 YO with poorly conrolled HTN. P-72, BP- 180/102, S4 Heard. serum NA= 142, K=2.4, CCreatinine clearence= 1. Angiogram shows narrowing of right renal artery. What will be the value of Renin and Aldos? Both Increased?

4) Sryringomyllia type picture with loss of pain and temp of upper limb. other sensations normal. Its not spinothalamic tract. Is it ant white commisure?

5) A mother of 4 who is having trouble keeping up with her bills and putting food on the table with the children not helping in her daily chores and fighting amongst themselves.
Is the answer call child protection service? or check childrens diet? or tell the mother to decrease her stress levels?

 

[tigress]

1) it was the tricuspid valve

2)no, but I don't remember the other answer choices

3)you should read about renal artery stenosis because it's an important concept--the kidney perceives reduced blood flow and renin increases, and as a result aldosterone will also increase

4)think about where a syrinx is--it's the anterior white commissure

5)the kids are showing all symptoms of carbon monoxide poisoning and the mother says she has had to use her space heater or generator or something to save money

 

[tigress]

I thought 11 was much easier than 7. I think it just goes to show that a lot of it has to do with your particular strengths and weaknesses.

Here's a question: this woman comes in with all the typical symptoms of hypothyroidism, but she also has symptoms of hypocalcemia. So the answer must have been hypothyroidism, but why would she have the additional hypoparathyroid symptoms?

This is one of the questions I wanted to ask too. Anybody?

 

[Dr McSexy]

I don't remember the question exactly.... but did it mention a surgical hx for thyroid removal or infer it in anyway?

If so, that could be why she has hypocalcemia due to lack of PTH regulation as back in the day before imaging advances, the parathyroid glands used to be accidentally removed during thyroid removal.

 

[lrkoehle]

I thought 11 was much easier than 7. I think it just goes to show that a lot of it has to do with your particular strengths and weaknesses.

Here's a question: this woman comes in with all the typical symptoms of hypothyroidism, but she also has symptoms of hypocalcemia. So the answer must have been hypothyroidism, but why would she have the additional hypoparathyroid symptoms?

Those were all actually symptoms of hypothyroidism as well, albeit somewhat lesser known symptoms, but they're all listed on the GT hypothyroidism card (which I know is zero help if you don't do GT, but my point is more that they are known symptoms not uncommonly seen).

 

[lrkoehle]

hy guys before i say anything i would like to thank all you guys for all your input it has really helped me !

1) In the question where it asks to identify which valve is one replaced on the two xrays? whats the answer? Its not mitral.

2) 80 YO women with h/o DM2, HTN, Dementia and smoking came with agitation and chest pain. bp-180/100, RR-32, P-120. Bilat crakles heard on ausc. ejection systolic mumur at apex. ECG:- ST elevation of anterolat leads.

Is is cerebrovascular accident?

3) 50 YO with poorly conrolled HTN. P-72, BP- 180/102, S4 Heard. serum NA= 142, K=2.4, CCreatinine clearence= 1. Angiogram shows narrowing of right renal artery. What will be the value of Renin and Aldos? Both Increased?

4) Sryringomyllia type picture with loss of pain and temp of upper limb. other sensations normal. Its not spinothalamic tract. Is it ant white commisure?

5) A mother of 4 who is having trouble keeping up with her bills and putting food on the table with the children not helping in her daily chores and fighting amongst themselves.
Is the answer call child protection service? or check childrens diet? or tell the mother to decrease her stress levels?

On your #2, it was acute coronary syndrome (if I am remembering the question correctly).

#4 is more an issue of the "best answer," which as tigress pointed out is in fact ant white comm. However, that is where the spinothalamic tract decussates, so it seems like it is technically correct (although not "the best"). It's not supper clear cut though, so that's probably why they dumped it and put it in an NBME instead of the real thing.

1) it was the tricuspid valve

2)no, but I don't remember the other answer choices

3)you should read about renal artery stenosis because it's an important concept--the kidney perceives reduced blood flow and renin increases, and as a result aldosterone will also increase

4)think about where a syrinx is--it's the anterior white commissure

5)the kids are showing all symptoms of carbon monoxide poisoning and the mother says she has had to use her space heater or generator or something to save money

On the CT imaging one, just so I understand how you know it's tricuspid, did she have TWO new valves (i.e. mitral and tricuspid)? I realize now that the arrows were pointing to the more right sided one, but I was just so thoroughly confused at the time that my brain couldn't figure anything out on that question.

 

[tigress]

Those were all actually symptoms of hypothyroidism as well, albeit somewhat lesser known symptoms, but they're all listed on the GT hypothyroidism card (which I know is zero help if you don't do GT, but my point is more that they are known symptoms not uncommonly seen).

I actually did use GT during the semester, but not for boards (my subscription ran out). I'm not the biggest fan. Anyway, just because it's on a GT card isn't a good enough reason to assume those are actual symptoms of hypothyroidism. I've never read of hypothyroidism presenting with hypocalcemic symptoms. It just seemed like a poorly-written question, I guess. (Although the best answer still would have been hypthyroidism, in retrospect, because of all of the clearly hypothyroid symptoms).

 

[tigress]

On the CT imaging one, just so I understand how you know it's tricuspid, did she have TWO new valves (i.e. mitral and tricuspid)? I realize now that the arrows were pointing to the more right sided one, but I was just so thoroughly confused at the time that my brain couldn't figure anything out on that question.

Yup, she had two new valves, and it was pointing to the tricuspid.

One thing I realized taking this was how exhausted I was after 4 blocks of 50. I'm glad my school is doing a mock of the full-length exam (by using both UW tests back to back), which I'm taking this week. I need to make sure I can last that long!

 

[msbbc833]

Goodness. I missed 16 out of 200 and got a 250 on NBME 11.
I got a 260 on the school administered CBSE in March. Can someone tell me which is more predictive? I also got a 254 on NBME 12 about 2 weeks ago.

 

[lrkoehle]

I actually did use GT during the semester, but not for boards (my subscription ran out). I'm not the biggest fan. Anyway, just because it's on a GT card isn't a good enough reason to assume those are actual symptoms of hypothyroidism. I've never read of hypothyroidism presenting with hypocalcemic symptoms. It just seemed like a poorly-written question, I guess. (Although the best answer still would have been hypthyroidism, in retrospect, because of all of the clearly hypothyroid symptoms).

Maybe I need to be refreshed on all symptoms she was presenting with, but I am pretty sure they all fit hypothyroidism, including sluggish reflexes. I just did a quick check of wikipedia and the symptoms I remember from that question were listed there for hypothyroidism (again, I know this is not a definitive source either). What were the hypoparathyroidism specific symptoms? My memory is getting foggy for the specifics of the questions on the exam, so like I said, I am probably forgetting a few of them. It wouldn't surprise me for it to just be a poor question, hence why they dumped it into an NBME instead of a real exam.

 

[boaz]

and this one...
20 r old man is brought to the ER 4 hrs after gunshot wound to forearm during hunting accident. exploratory operation shows that the tendon of the flexor carpi radialis is severed and there is a communuted fracture of the distal radius, ..... functional loss would be insiginficant?

a) flexor capri ulnaris
b) flexor digitorum profundus
c) flexor digitorum superficialis
d) palmaris longus
e) pronator teres


i thought c.. but its not haha

Can anyone comment on this? I chose B but got it wrong. Maybe it's D?

 

[VisionaryTics]

Can anyone comment on this? I chose B but got it wrong. Maybe it's D?

It's D. Palmaris longus is congenitally absent in 15% of people, and it's commonly harvested for tendon grafts.

 

[missmedschool]

32. A 40 year old woman with chronic paraplegia caused by MS is brought to the physician because of severe, debilitating muscle cramps for the past 3 weeks. Treatment with baclofen resolves her muscle cramps. Which of the followign receptors most likely decreased hte muscule spasticity in this patient?:

a. alpha 2 receptor
b. beta 2 receptor
c. GABA receptor
d. calcium-sensing receptor
e. ryanodine receptor

My skeletal phys is shaky and I'm pissed that I missed the above one. Can someone please explain the pathophys behind this and the correct answer?

2.32.
Alveolar ventilation and CO2 production double during moderate exercise in a 48-year-old man. Which of the following best describes the effect on arterial Pco2?


Divided by 4
Divided by 2
Not changed
Doubled
Quadrupled

Apparently the answer to the above one is not changed. Can someone explain the reasoning behind this one as well? Thanks!

 

[VisionaryTics]

32. A 40 year old woman with chronic paraplegia caused by MS is brought to the physician because of severe, debilitating muscle cramps for the past 3 weeks. Treatment with baclofen resolves her muscle cramps. Which of the followign receptors most likely decreased hte muscule spasticity in this patient?:

a. alpha 2 receptor
b. beta 2 receptor
c. GABA receptor
d. calcium-sensing receptor
e. ryanodine receptor

My skeletal phys is shaky and I'm pissed that I missed the above one. Can someone please explain the pathophys behind this and the correct answer?

2.32.
Alveolar ventilation and CO2 production double during moderate exercise in a 48-year-old man. Which of the following best describes the effect on arterial Pco2?


Divided by 4
Divided by 2
Not changed
Doubled
Quadrupled

Apparently the answer to the above one is not changed. Can someone explain the reasoning behind this one as well? Thanks!

First one - Bacolfen is a GABA (B) agonist. GABA and glycine are inhibitory neurotransmitters in the spinal cord, so stimulating GABA decreases muscle spasticity. A correlate to this is tetanus toxin. Tetanus blocks the inhibitory neurons of the spinal cord (GABA/glycine), so you get a spastic paralysis.

Second one - PaCO2 ~ CO2 production / ventilation. So even though production doubled, ventilation doubled, and arterial CO2 is unchanged. Venous CO2 would be increased, though.

 

[missmedschool]

thanks

 

[Convalaria]

hey

here's my 5 cents:

1. 27-year-old guy is brought to the emergency department 30 minutes after tonic-clonic seiz. His mother says that has schizophrenia and 3 mo ago stopped taking haloperidol. Past 2 mo he drinks a lot of water to 'get rid of toxins'. T37.8, 90/min, 110/78, skin turgor normal, Na - 116, K - 4.2, HCO3 - 18, urine gravity - 1.002. No abnormalities on urine dipstick test.
A. adverse effect of haloperidol
B. hypothyroidism
C. psychogenic polydipsia
D. SIADH
E. tumor in CNS

I answered wrong because overthought this question..and now looking back I think the correct answer is C, right?

2. the one with MR brain angoiography:
56 yo man 1 hour after sudden onset of left sided weakness. On examination: lower 2/3 of the face, left upper, lower extremity are weak, deep tendon reflexes - hyperactive in both upper and lower extrem., but upper>lower. Which artery is the cause of all this stuff?
I chose D because thought of posterior cerebral art. MR is attached. So correct answ is A?

3. Question about the role of adipose tissue in gluconeogenesis. So does glucagon activate hormone-sensitive lipase?? In Kaplan I found that HSL is activated only by epinephrine and cortisol.

4. 58 yo man, 2 packs of ciggaretts daily 30 years with severe bronchitis:
pH pCO2 pO2
A. 7.30 18 95
B. 7.32 65 60
C. 7.42 40 95
D. 7.50 55 90
E. 7.52 20 60
I know that this is probably not difficult question to be wrong at, but still.
I guess here we have patient with acidosis that has been compensated by tachypnoe since bronchitis is severe, that means that the correct answer is E?

5. Experiment with myocardium ischemia: increase in myocyte diameter, sarcolemma blebbing. Most directly due to:
- decreased sarcoplasmic ATP?

6. Question about progressive degenerative neurologic disease in the population of the small island in the Pacific Ocean. I found that the answer is HIV.
I got lost with all these who on whom depends:
RNA dependant RNA pol
RNA dependant DNA pol
DNA dependant RNA pol
DNA dependant DNA pol
RNA pol is for RNA-viruses, and DNA pol is for DNA viruses, am I right so far? how you distinguish what virus depends on DNA, what on RNA..? i'm just freaking out, these seem so simple, but I can't remember and I feel that my head is so close to explode...

Thanks in advance!

 

[HelpPleaseMD]

Sorry that I dont have time to explain the answers but for what you posted
1)C
2) A
3) HSL
4)B
5) sarcoplasmic ATP
6) you know its HIV cause they state its RNA dependent DNA polymerase

The reason the person who smokes has high co2 instead of low co2 is cause he has trouble exhaling. its copd most likely chronic bronchitis (blue bloaters. fat person with a really tough time breathing cause of all the crap stuck in their breathing track.

hope that helps somewhat lol

 

[Convalaria]

maybe when you have time to explain:

Sorry that I dont have time to explain the answers but for what you posted
1)d - SIADH due to?
2) A - it is middle cerebral art, right?
3) HSL
4)B
5) sarcoplasmic ATP
6) you know its HIV cause they state its RNA dependent DNA polymerase

The reason the person who smokes has high co2 instead of low co2 is cause he has trouble exhaling. its copd most likely chronic bronchitis (blue bloaters. fat person with a really tough time breathing cause of all the crap stuck in their breathing track.

hope that helps somewhat lol

thank you!

 

[HelpPleaseMD]

sorry about #1 its C. I mistyped. And yea its the middle cerebral

 

[Convalaria]

sorry about #1 its C. I mistyped. And yea its the middle menigeal

meningeal or cerebral?

 

[HelpPleaseMD]

lol long day

 

[lp80]

can't find correct answers . HELP!
1. A 21 y.o.women brought to the ER by parents because of personality changes for the past 8 mo: talks to someone who wasn't there, social withdrawal, collect old newspapers and other garbage,stopped attending classes....Dx:
a.bipolar disorder
b.obsessive-comp.dis
c.schizophrenia
d.schizotypal personality dis. ( wrong)
e.social phobia

2. a 17 e.o.girl has not been menstruating for 15month. BMI 17, she is dieting,takes 800cal/day, exercises for3hr.daily.Q: Findings:
a. decreased circadian variability of free thyroxine conc.
b.decr. GRH pulsatility
c.incr. adrenocorticotropic hormone pulsatility
d.incr. diurnal variability of FSH concentr. ( wrong)
e.reversal of diurnal variability if GH conc.

3. A 27 y.o. man with ALL takes methotrexate. What enzyme does it inhibit?
a. adenosine deaminase
b. DNA polymerase
c. HGPRT
d.thymidylate synthase
e.xanthine oxidase
I know its DHFR but there is no such answer. The only thing that comes in to my mind is thymidylate synthase ( its also works in de novo pyrimidine synthesis) but that is target for 5- FU....

4. a deficiency of which of the following causes increase serum conc. of phenylalanine and decrease conc. of serotonin and dopamine in the brain?
a. biotin
b. glutamate
c. NADH
d. tetrahydrobiopterin
e. vit.B12

 

[HelpPleaseMD]

1) c 2) gnrh? 3)d. if dhfr is inhibited thymidine cannot be made 4) D

 

[lp80]

thanks

 

[lp80]

hey

2. the one with MR brain angoiography:
56 yo man 1 hour after sudden onset of left sided weakness. On examination: lower 2/3 of the face, left upper, lower extremity are weak, deep tendon reflexes - hyperactive in both upper and lower extrem., but upper>lower. Which artery is the cause of all this stuff?
I chose D because thought of posterior cerebral art. MR is attached. So correct answ is A?

Is it A because D is incorrect? I also put D and was pretty sure about Weber syndrome. There is CST and corticobulbar tract damage....

 

[Radonkulous]

Can someone answer the following 3 questions?

Person fractures surgical neck of humerus. Where is sensation lost?

Newborn screening test for deafness. What's the benefit of doing this?

Child has Type I DM. What is seen on pancreatic biopsy? I put atrophy and fibrosis but is it lymphocytic infiltrate? I thought this happens way prior to symptom appearance and by the time symptoms develop there is fibrosis of the pancreatic tissue.

Thanks again.

 

[HelpPleaseMD]

Can someone answer the following 3 questions?

Person fractures surgical neck of humerus. Where is sensation lost? - axillary nerve so lateral arm

Newborn screening test for deafness. What's the benefit of doing this? so the newborn can hear and learn language

Child has Type I DM. What is seen on pancreatic biopsy? I put atrophy and fibrosis but is it lymphocytic infiltrate? I thought this happens way prior to symptom appearance and by the time symptoms develop there is fibrosis of the pancreatic tissue. I thought the same thing you did but the answer is lymphocytic infiltrate. maybe it is because its still an on going process because diabetes presents after a critical number of B cells are destroyed? I dunno thats just a guess

Thanks again.

.

 

[Radonkulous]

Thanks for the reply. With regards to the newborn screen, why isn't cost effectiveness a possibility?

 

[HelpPleaseMD]

I did this test weeks ago so for that question could you provide all the choices?

 

[Radonkulous]

A. Although congenital hearing loss occurs infrequently, screening is cost effective
B. Early diagnosis and treatment of hearing loss will prevent delay in motor development
C. Identification and treatment of hearing loss before the age of 6 months will allow for better prognosis of speech and language development.
D. Newborn screening allows for more time to prepare hearing aids so the newborn can be fitted with them when he or she reaches the age of 1 year
E. Newborn screening will identify those children who will require a cochlear implant after the age of 5 years

 

[HelpPleaseMD]

A. Although congenital hearing loss occurs infrequently, screening is cost effective
B. Early diagnosis and treatment of hearing loss will prevent delay in motor development
C. Identification and treatment of hearing loss before the age of 6 months will allow for better prognosis of speech and language development.
D. Newborn screening allows for more time to prepare hearing aids so the newborn can be fitted with them when he or she reaches the age of 1 year
E. Newborn screening will identify those children who will require a cochlear implant after the age of 5 years

Answer is definitely C. In behavorial type questions, the touchy feely compassionate answer is almost always the correct answer. + if congenital hearing loss occurs rarely it isnt cost effective cause I doubt hearing aids/speech therapy/whatever else you need will cost more than the screening for an infrequent event. At least that is how I reasoned it out

 

[surgndoc]

How do you see the total number of questions missed? Do you need to get the advanced feedback version of the test that costs $60 instead of $50?

I can only see my breakdown for each of the disciplines.

 

[jatt12]

How do you see the total number of questions missed? Do you need to get the advanced feedback version of the test that costs $60 instead of $50?

I can only see my breakdown for each of the disciplines.

Yes

 

[brokemedstudent]

There was a question concerning gastric lap band surgery, and I think the question was which ligament should the band be placed around. Does anybody know the correct answer? I don't remember the answer choices. (I don't have expanded feedback.)

The question was "A 38-year-old man is schedules to undergo a gastric reduction for treatment of morbid obesity. During the procedure to reduce stomach volume, a plastic band will be placed around the upper portion of the stomach. To encircle the stomach, the band will pass through which of the following structures?

A. Hepatoduodenal ligament
B. Lesser Omentum
C. Phrenicocolic ligament
D. Splenorenal ligament
E. Transverse mesocolon

 

[brokemedstudent]

For the euthyroid in pregnancy with a TSH of 2 and T4 of 14. What causes these findings?

Androgens
Progesterone
Estrogen
Prolactin
Corticosteroids

Is it estrogens?

On page 322 of FA it says increase in TBG in pregnancy or OCP use (estrogen increases TBG). DIT lecturer stated that in this situation total should increase and free T4 is normal.

 

[momgracea]

Stimulation of the baroreceptors causes overall Parasympathetic upregulation and Sympathetic downregulation which means the heart slows down. This is why they do carotid stimulation as a way to rx PVST. Valsalva would do the same by increasing intrathoracic pressure pressing on those baroreceptors.

Just as an FYI... stimulation can cause bradycardia, vasodilation or both. It's just that bradycardia is most common according to Medscape:

Clinically, 3 types of CSH (Carotid Sinus Hypersensitivity) have been described.

1. The cardioinhibitory type comprises 70-75% of cases. The predominant manifestation is a decreased heart rate, which results in sinus bradycardia, atrioventricular block, or asystole due to vagal action on sinus and atrioventricular nodes. This response can be abolished with atropine.
2. The vasodepressor type comprises 5-10% of cases. The predominant manifestation is a vasomotor tone decrease without a change in heart rate. The significant resulting drop in blood pressure is due to a change in the balance of parasympathetic and sympathetic effects on peripheral blood vessels. This response is not abolished with atropine.
3. The mixed type comprises 20-25% of cases. A decrease in heart rate and vasomotor tone occurs.


See http://emedicine.medscape.com/article/153312-overview#a0104 if you are interested.

 

[bennybrak]

The question was "A 38-year-old man is schedules to undergo a gastric reduction for treatment of morbid obesity. During the procedure to reduce stomach volume, a plastic band will be placed around the upper portion of the stomach. To encircle the stomach, the band will pass through which of the following structures?

A. Hepatoduodenal ligament
B. Lesser Omentum
C. Phrenicocolic ligament
D. Splenorenal ligament
E. Transverse mesocolon

B. Lesser Omentum

 

[ohyeahbaby]

I went through the whole thread, and I couldn't find answers to these questions. Any help would be very much appreciated. My test is in a few days, and I found it a little unsettling that most of the questions I got wrong weren't even mentioned in this thread.

1- 75 year old comes to physician because of leg swelling. physical exam shows JVD. Lungs clear to auscultation. imaging will show enlargement of?

(a) IVC and LA
(b) LA and LV
(c) RA and LA
(d) RA and RV
(e) RV and LA

any way you can also PLEASE explain to me why you put your answer? I'm having trouble with these questions and I was so sure the answer was LA and LV, i.e. answer choice B. My reasoning was that left heart failure was more common than right heart failure, and that the most common reason for right heart failure was left failure. I thought the heart was having trouble pumping out the blood from the LV, so the blood was backing up into the LA, so the blood backed up all the way into the other side causing the right heart symptoms (i.e. JVD).

2- 45 yr old woman, 3 month history decreased energy and concentration. Tingling in both hands, constipation, 4lb wt gain. Appears apathetic. Coarse hair, doughy skin, tapping median nerves results in parasthesias. Relaxation of muscle stretch reflexes is slowed.

half this question stem sounds like hypothyroidism, and the other half sounds like a problem with calcium. Isn't there a technique where you place a blood pressure cuff on someone's arm, and if they're having calcium issues, the hands spasms or something? i may be mixing stuff up i guess. The word "tapping" threw me off - any clue what they were trying to get at? Anything important we've learned that involves tapping?

3- 79 yo woman brought in by her son because she's having chest pain. Type 2 DM. Two packs a day smoker until 70 yo. Chest x-ray shows mildly enlarged cardiac silhouette. ST segment elevation. What's the dx?

(a) acute coronary syndrome
(b) acute pericarditis
(c) bilateral pneumonia
(d) cerebrovascular event
(e) pulmonary embolism

4- TB test. The question is asking about what cell is predominant. I put CTL. Someone earlier in this thread said that the answer is macrophages. I have never gotten a single one of these TB skin test questions right. can someone PLEASE explain to me why it's not CTLs? actually here's my question: if a question is talking about a TB skin test, will there ever be a time when the answer is going to be CTLs? I'm frustrated because I was so sure I got it right when I put CTLs.

5- 24 yo dude brought in by his wife. 2 day history of progressive confusion. His words look pretty but don't make any sense, etc. etc etc

(a) toxoplasma
(b) HSV encephalitis
(c) HIV encephelopathy
(d) meningococcal meningitis
(e) subdural empyema

Will someone please tell me what the difference is between encephalopathy and encephalitis? is it that one of them involves foreign organisms and the other doesn't? Or is it just that one is reversible and the other isn't?

thank you again for all your help!

 

[RedSoxSuck]

1. Hypertension and Raynaud. Which drug for tx of both? Captopril, clonidine, losartan (wrong), nifedipine,propranolol.

2. 24 y/o man, 2day history of confusion. Temp is 38.3 C. When speaking, he enunciates clearly but his words/word like utterances make little sense. Doesn't follow any commands. what could it be
a) cerebral toxoplasmosis
b) HSV encephalitis Why?
c) HIV encephalopathy
d) meningococcal meningitis
e) subdural empyema

3. PE shows guarding and rebound tenderness. Specific gravity is >1.020. Many segmented neutrophils and numerous leuckocytes. Type of fluid?
Ascites
Blood
Exudate
Lyphedema
Transduate

4. 18 yo man. he has had pharyngitis that resolved spontaneously. Protein 2+, RBC cast, serum creatinine is 2.1. Blood cultures are negative.
Grp B strep
S. Mutans
S. pneumo
Grp A strep
Viridans

5. Parkinsons disease. parkin gene encodes are ubiquitin protein ligase. Which of the following pathological processes is most likely to occur in this patient as a result of these mutations?
Absence of neuronal proteosomes
accumulation of aggregated proteins within the cytoplasm of neurons
excess dopaminergic neurons in bg
increased protein aggreated with the nuclues of neurons (wrong, i was thinking lewy bodies)
proliferation of pigmented neurons in subst nigra

6. 45 yo man has partial colectomy for carcinome. Which of the following indicated highest likelihood for survival for 5 years after the resection of the lesion.

Moderately diferentiated carcinoma invading the muscularis
mucin producing carcinome invasive to the serosal surface
mucrin producing carcinome metastatic to regional nodes
poorly differentiated carcinoma confined to mucosa
well differentiated carcinome with hepatic metastasis

7. 72 yo man had moderate progressive dementia for last 3 years. 25 yr history of hypertension. 5 yr history of episodic dysarthria and wkness of right upper extermity. Dx?

Aids dementia
Alzheimer dementia (wrong)
Huntington
Vascular dementia (didnt pick this because i thought it has quick onset)
parkinsons

Thank you!

 

[ohyeahbaby]

1. Hypertension and Raynaud. Which drug for tx of both? Captopril, clonidine, losartan (wrong), nifedipine,propranolol.

2. 24 y/o man, 2day history of confusion. Temp is 38.3 C. When speaking, he enunciates clearly but his words/word like utterances make little sense. Doesn't follow any commands. what could it be
a) cerebral toxoplasmosis
b) HSV encephalitis Why? no clue
c) HIV encephalopathy
d) meningococcal meningitis
e) subdural empyema

3. PE shows guarding and rebound tenderness. Specific gravity is >1.020. Many segmented neutrophils and numerous leuckocytes. Type of fluid?
Ascites
Blood
Exudate
Lyphedema
Transduate

4. 18 yo man. he has had pharyngitis that resolved spontaneously. Protein 2+, RBC cast, serum creatinine is 2.1. Blood cultures are negative.
Grp B strep
S. Mutans
S. pneumo
Grp A strep
Viridans

5. Parkinsons disease. parkin gene encodes are ubiquitin protein ligase. Which of the following pathological processes is most likely to occur in this patient as a result of these mutations?
Absence of neuronal proteosomes
accumulation of aggregated proteins within the cytoplasm of neurons
excess dopaminergic neurons in bg
increased protein aggreated with the nuclues of neurons (wrong, i was thinking lewy bodies)
proliferation of pigmented neurons in subst nigra

6. 45 yo man has partial colectomy for carcinome. Which of the following indicated highest likelihood for survival for 5 years after the resection of the lesion.

Moderately diferentiated carcinoma invading the muscularis
mucin producing carcinome invasive to the serosal surface
mucrin producing carcinome metastatic to regional nodes
poorly differentiated carcinoma confined to mucosa
well differentiated carcinome with hepatic metastasis

7. 72 yo man had moderate progressive dementia for last 3 years. 25 yr history of hypertension. 5 yr history of episodic dysarthria and wkness of right upper extermity. Dx?

Aids dementia
Alzheimer dementia (wrong)
Huntington
Vascular dementia (didnt pick this because i thought it has quick onset)
parkinsons

Thank you!

For #2, I had no idea... I was also wondering about the same thing

 

[RedSoxSuck]

For #2, I had no idea... I was also wondering about the same thing

For vascular dementia. Why is it so? I thought vascular dimentia would have a quick onset.

 

[ohyeahbaby]

For vascular dementia. Why is it so? I thought vascular dimentia would have a quick onset.

Honestly the second I read hypertension, I started looking for "vascular dementia" in the answer options because I figured the dude was having microinfarcts. Also I've just never seen any of the other answer options presented to us in the context of hypertension. I'm sure they constantly happen in ppl with HTN, but I've just never seen them on practice questions. Also, I always thought vascular dementia's time line was the opposite of quick onset, i.e. more of a chronic thing.

I found the second paragraph (signs and symptoms) very helpful:

http://en.wikipedia.org/wiki/Multi-infarct_dementia#Signs_and_symptoms

 

[ohyeahbaby]

I went through the whole thread, and I couldn't find answers to these questions. Any help would be very much appreciated. My test is in a few days, and I found it a little unsettling that most of the questions I got wrong weren't even mentioned in this thread.

1- 75 year old comes to physician because of leg swelling. physical exam shows JVD. Lungs clear to auscultation. imaging will show enlargement of?

(a) IVC and LA
(b) LA and LV
(c) RA and LA
(d) RA and RV
(e) RV and LA

any way you can also PLEASE explain to me why you put your answer? I'm having trouble with these questions and I was so sure the answer was LA and LV, i.e. answer choice B. My reasoning was that left heart failure was more common than right heart failure, and that the most common reason for right heart failure was left failure. I thought the heart was having trouble pumping out the blood from the LV, so the blood was backing up into the LA, so the blood backed up all the way into the other side causing the right heart symptoms (i.e. JVD).

2- 45 yr old woman, 3 month history decreased energy and concentration. Tingling in both hands, constipation, 4lb wt gain. Appears apathetic. Coarse hair, doughy skin, tapping median nerves results in parasthesias. Relaxation of muscle stretch reflexes is slowed.

half this question stem sounds like hypothyroidism, and the other half sounds like a problem with calcium. Isn't there a technique where you place a blood pressure cuff on someone's arm, and if they're having calcium issues, the hands spasms or something? i may be mixing stuff up i guess. The word "tapping" threw me off - any clue what they were trying to get at? Anything important we've learned that involves tapping?

3- 79 yo woman brought in by her son because she's having chest pain. Type 2 DM. Two packs a day smoker until 70 yo. Chest x-ray shows mildly enlarged cardiac silhouette. ST segment elevation. What's the dx?

(a) acute coronary syndrome
(b) acute pericarditis
(c) bilateral pneumonia
(d) cerebrovascular event
(e) pulmonary embolism

4- TB test. The question is asking about what cell is predominant. I put CTL. Someone earlier in this thread said that the answer is macrophages. I have never gotten a single one of these TB skin test questions right. can someone PLEASE explain to me why it's not CTLs? actually here's my question: if a question is talking about a TB skin test, will there ever be a time when the answer is going to be CTLs? I'm frustrated because I was so sure I got it right when I put CTLs.

5- 24 yo dude brought in by his wife. 2 day history of progressive confusion. His words look pretty but don't make any sense, etc. etc etc

(a) toxoplasma
(b) HSV encephalitis
(c) HIV encephelopathy
(d) meningococcal meningitis
(e) subdural empyema

Will someone please tell me what the difference is between encephalopathy and encephalitis? is it that one of them involves foreign organisms and the other doesn't? Or is it just that one is reversible and the other isn't?

thank you again for all your help!

my test is tomorrow morning - if someone can throw me a bone, I'd really appreciate it

 

[RedSoxSuck]

my test is tomorrow morning - if someone can throw me a bone, I'd really appreciate it

.....Stupid SDN

 

[RedSoxSuck]

my test is tomorrow morning - if someone can throw me a bone, I'd really appreciate it

1- 75 year old comes to physician because of leg swelling. physical exam shows JVD. Lungs clear to auscultation. imaging will show enlargement of?

(a) IVC and LA
(b) LA and LV
(c) RA and LA
(d) RA and RV
(e) RV and LA

Answer is D....well, i quickly drew out heart. Since lungs were clear, i figured there is nothing wrong with the lungs to problem must be before lungs aka Right heart. So i picked the one that had to do with right heart. All signs and symptoms were clearly pointing to right heart failure. Blood flows from RA to RV to LUNGS to LA and then LV. Not sure if that made any sense.

CTL...I got it wrong as well because i put CTL. Its wrong because CTLs are CD8 not CD4. So i guess we had to remember TH1 response and everything associated with that which includes IL2, IFN gamma, macrophages etc. CTL are not associated with granuloma

 

[Boardz]

I went through the whole thread, and I couldn't find answers to these questions. Any help would be very much appreciated. My test is in a few days, and I found it a little unsettling that most of the questions I got wrong weren't even mentioned in this thread.

1- 75 year old comes to physician because of leg swelling. physical exam shows JVD. Lungs clear to auscultation. imaging will show enlargement of?

(a) IVC and LA
(b) LA and LV
(c) RA and LA
(d) RA and RV
(e) RV and LA

any way you can also PLEASE explain to me why you put your answer? I'm having trouble with these questions and I was so sure the answer was LA and LV, i.e. answer choice B. My reasoning was that left heart failure was more common than right heart failure, and that the most common reason for right heart failure was left failure. I thought the heart was having trouble pumping out the blood from the LV, so the blood was backing up into the LA, so the blood backed up all the way into the other side causing the right heart symptoms (i.e. JVD).

2- 45 yr old woman, 3 month history decreased energy and concentration. Tingling in both hands, constipation, 4lb wt gain. Appears apathetic. Coarse hair, doughy skin, tapping median nerves results in parasthesias. Relaxation of muscle stretch reflexes is slowed.

half this question stem sounds like hypothyroidism, and the other half sounds like a problem with calcium. Isn't there a technique where you place a blood pressure cuff on someone's arm, and if they're having calcium issues, the hands spasms or something? i may be mixing stuff up i guess. The word "tapping" threw me off - any clue what they were trying to get at? Anything important we've learned that involves tapping?

3- 79 yo woman brought in by her son because she's having chest pain. Type 2 DM. Two packs a day smoker until 70 yo. Chest x-ray shows mildly enlarged cardiac silhouette. ST segment elevation. What's the dx?

(a) acute coronary syndrome
(b) acute pericarditis
(c) bilateral pneumonia
(d) cerebrovascular event
(e) pulmonary embolism

4- TB test. The question is asking about what cell is predominant. I put CTL. Someone earlier in this thread said that the answer is macrophages. I have never gotten a single one of these TB skin test questions right. can someone PLEASE explain to me why it's not CTLs? actually here's my question: if a question is talking about a TB skin test, will there ever be a time when the answer is going to be CTLs? I'm frustrated because I was so sure I got it right when I put CTLs.

5- 24 yo dude brought in by his wife. 2 day history of progressive confusion. His words look pretty but don't make any sense, etc. etc etc

(a) toxoplasma
(b) HSV encephalitis
(c) HIV encephelopathy
(d) meningococcal meningitis
(e) subdural empyema

Will someone please tell me what the difference is between encephalopathy and encephalitis? is it that one of them involves foreign organisms and the other doesn't? Or is it just that one is reversible and the other isn't?

thank you again for all your help!

1. lower extremity edema and jugular venous distension are signs of Right heart failure. You're right in saying left heart failure is MCC of right heart failure but _her lungs are clear_ so the left side is fine. That's why the answer's RV + RA.

2. I need to know the actual question and probably the answer choices to answer this but tinel's sign is tapping median nerve for carpal tunnel and the blood pressure cuff sign you're thinking of is troussea's sign of hypocalcemia.

3. i don't know why the answer wouldn't be A) acute coronary syndrome. According to UWorld: Diabetes is the #1 risk factor for coronary heart disease and Myocardial infarction is the #1 cause of death in diabetics.

4. CTLs have nothing significant to do with TB infection as far as I know. It's a CD4+ and Macrophage related type IV hypersensitivity response.

5. I don't know the exact difference b/w encephalitis and encephalopathy but i don't think it's beyond what a google search could uncover. The answer, it seems to me anyway, is HSV encephalitis. He's 24... no history of trauma in question stem (so not subdural), no history of HIV (so not HIV encephalitis or toxo most likely), no other evidence of meningitis etc...

hope this helps.

 

[ohyeahbaby]

1- 75 year old comes to physician because of leg swelling. physical exam shows JVD. Lungs clear to auscultation. imaging will show enlargement of?

(a) IVC and LA
(b) LA and LV
(c) RA and LA
(d) RA and RV
(e) RV and LA

Answer is D....well, i quickly drew out heart. Since lungs were clear, i figured there is nothing wrong with the lungs to problem must be before lungs aka Right heart. So i picked the one that had to do with right heart. All signs and symptoms were clearly pointing to right heart failure. Blood flows from RA to RV to LUNGS to LA and then LV. Not sure if that made any sense.

CTL...I got it wrong as well because i put CTL. Its wrong because CTLs are CD8 not CD4. So i guess we had to remember TH1 response and everything associated with that which includes IL2, IFN gamma, macrophages etc. CTL are not associated with granuloma

1. lower extremity edema and jugular venous distension are signs of Right heart failure. You're right in saying left heart failure is MCC of right heart failure but _her lungs are clear_ so the left side is fine. That's why the answer's RV + RA.

2. I need to know the actual question and probably the answer choices to answer this but tinel's sign is tapping median nerve for carpal tunnel and the blood pressure cuff sign you're thinking of is troussea's sign of hypocalcemia.

3. i don't know why the answer wouldn't be A) acute coronary syndrome. According to UWorld: Diabetes is the #1 risk factor for coronary heart disease and Myocardial infarction is the #1 cause of death in diabetics.

4. CTLs have nothing significant to do with TB infection as far as I know. It's a CD4+ and Macrophage related type IV hypersensitivity response.

5. I don't know the exact difference b/w encephalitis and encephalopathy but i don't think it's beyond what a google search could uncover. The answer, it seems to me anyway, is HSV encephalitis. He's 24... no history of trauma in question stem (so not subdural), no history of HIV (so not HIV encephalitis or toxo most likely), no other evidence of meningitis etc...

hope this helps.

thank you BOTH! this is exactly the information I was looking for

 

[dendrites]

Can someone explain why ACA is the answer:

"Pt with left sided weakness in the lower 2/3 of L face. Weak upper extremity and moderate lower extremity weakness. Hyperactive reflexes in both upper and lower limb"

I thought the ACA had to do with lower limb (not face and upper limb)

thanks

 

[dendrites]

anyone?