NBME 12 discussion

[titan25]

1 v max 1 enzyme is 300 and 2 nd 30 compare the Km values

km1 is 10 times km 2
km1 is 1/10 km2
we cant compare


2 upregulation of which protects from ARDS is IL 10

3 which anti hypertensive restores back potassium other k sparing

4 a 14 years old brougt to physian because mostly sleeping withdrawn and complaining of abdomen pain 3 weeks , what history will u take first...should we recretion drug history....options school history , devlopmental, family history

5 a drug given in two patients obese and normal given same doses graph ploted with conc on y axis and time on x , slope of normal person is greater
compared to normal person drug x in obese has

greater VD/ lower bioavailability / higher clearance/ shorter absorption

6 pedigree given four genrations AD 1st genration gene seq 4 5 6 changes to 156 cause...is it recombination

7 cytoplasmic enzyme mutated at 127 alanine replaced by serine why reduction of enzyme activity

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[epicccfail]

Sustaining/attaining viagra for both. Additionally if you chose "B" think of all the other issues you'd have throughout your body.

Good call, not sure what I was thinking. For some reason I blocked out everything else. Its getting to me...

 

[doctoritis]

Alright, I'm struggling with the question about the 45 year old women who presents with confusion, she has multiple sclerosis, 99 F, pulse 72, slow respiration at 8/min, BP a little low at 116/66, she has decreased lung volume, distant breath sounds, and lungs are clear to auscultation, minimal gag response. pH = 7.12, pO2 = 76 mmhg, pCO2 = 50 mmhg.

A. acute respiratory distress syndrome
B. aspiration pneumonia
C. opioid overdose
D. pulmonary embolism
E. upper airway obstruction

i know the answer is C = opioid overdose, but i'm not really sure how to get there. i get how some of the symptoms make sense in context of opioid overdose, but i'm not sure why other answer choices can be eliminated.

B - since the lungs are clear to auscultation = that seems like you can eliminate aspiration pneumonia.
D - in a pulmonary embolism = perfusion problem that leads to hyperventilation -> she actually has a high CO2 and is breathing slow, so that can be eliminated.


i'm a little torn on the other answer choices .. especially upper airway obstruction as that should present as a ventilation issue giving similar pO2 and pCO2 findings as we find here (they should both be working their way towards venous values). i also don't 100% understand why ARDS can be eliminated (i guess because lungs appear clear and we should see some pulmonary edema? - but i don't really get the full reasoning here).

i do get why opioid overdose makes some sense ... but i still wouldn't be quick to pick it - i mean we definitely see the CNS depression and respiratory depression ... but what about the distant breath sounds and decreased lung volumes?? - make's me think there is some obstruction/inflammatory obstruction going on (low fever, etc)

so if anyone can explain A, C, and E - i'd really appreciate it.

 

[pvtbacon]

Alright, I'm struggling with the question about the 45 year old women who presents with confusion, she has multiple sclerosis, 99 F, pulse 72, slow respiration at 8/min, BP a little low at 116/66, she has decreased lung volume, distant breath sounds, and lungs are clear to auscultation, minimal gag response. pH = 7.12, pO2 = 76 mmhg, pCO2 = 50 mmhg.

A. acute respiratory distress syndrome
B. aspiration pneumonia
C. opioid overdose
D. pulmonary embolism
E. upper airway obstruction

i know the answer is C = opioid overdose, but i'm not really sure how to get there. i get how some of the symptoms make sense in context of opioid overdose, but i'm not sure why other answer choices can be eliminated.

B - since the lungs are clear to auscultation = that seems like you can eliminate aspiration pneumonia.
D - in a pulmonary embolism = perfusion problem that leads to hyperventilation -> she actually has a high CO2 and is breathing slow, so that can be eliminated.


i'm a little torn on the other answer choices .. especially upper airway obstruction as that should present as a ventilation issue giving similar pO2 and pCO2 findings as we find here (they should both be working their way towards venous values). i also don't 100% understand why ARDS can be eliminated (i guess because lungs appear clear and we should see some pulmonary edema? - but i don't really get the full reasoning here).

i do get why opioid overdose makes some sense ... but i still wouldn't be quick to pick it - i mean we definitely see the CNS depression and respiratory depression ... but what about the distant breath sounds and decreased lung volumes?? - make's me think there is some obstruction/inflammatory obstruction going on (low fever, etc)

so if anyone can explain A, C, and E - i'd really appreciate it.

Normally, with ARDS or an upper airway obstruction, you'd get a buildup of CO2 and this should see hyperventilation via stimulation of peripheral/central chemoreceptors. Because the patient is still showing signs of hypoventilation despite this increase in CO2, you should automatically think of central respiratory depression.

I can't explain the distant breath sounds but the decreased lung volume could be because she's taking shallow breaths.

 

[doctoritis]

That's fair, I can live with that explanation. The hypoventilation drives the point home. Thank you!

 

[MLT2MT2DO]

The question that has the guy fasting for 1 week (had a bunch of arrows):

Why is 2,6 Fructosebisphosphate elevated?

 

[coolforschool]

The question that has the guy fasting for 1 week (had a bunch of arrows):

Why is 2,6 Fructosebisphosphate elevated?

It's not. F-2,6-BP and PK are down while G-6-Pase and PEPCK are up. It didn't show up on my incorrects.

 

[MLT2MT2DO]

It's not. F-2,6-BP and PK are down while G-6-Pase and PEPCK are up. It didn't show up on my incorrects.

Ok, that makes sense to me then. Crappy internet key said it was "A" (only PK down), which I couldn't wrap my head around

 

[sharklasers]

Anyone else think this NBME was a bit tougher than the other ones?

 

[sharklasers]

Ok, that makes sense to me then. Crappy internet key said it was "A" (only PK down), which I couldn't wrap my head around

Can you explain each one?

First Aid says that after 3 days you rely on adipose stores for energy, so I figured everything would be decreased?

And even if you are still breaking down proteins, I figure there might be some GNG going on but certainly less than baseline.

 

[startswithb]

Anyone else think this NBME was a bit tougher than the other ones?

Yes. Do you know the one that asked about the change in serine for alanine in an enzyme? Does it prevent the enzyme from being phosphorylated?

 

[sharklasers]

Yes. Do you know the one that asked about the change in serine for alanine in an enzyme? Does it prevent the enzyme from being phosphorylated?

yeah i think so. i vaguely remember serines being a site for phosphorylation from m1 biochem

 

[sharklasers]

Losartan. Angiotensin II stimulates adrenal release of aldosterone. ACEI and ARBs block this.

i put this, but wouldn't atenolol also block beta1 receptors, causign a decrease in renin, leading to a decrease in aldosterone?

i guess its not as direct as losartan, but it seems to be a prefectly reasonable answer, no?

 

[MLT2MT2DO]

Can you explain each one?

First Aid says that after 3 days you rely on adipose stores for energy, so I figured everything would be decreased?

And even if you are still breaking down proteins, I figure there might be some GNG going on but certainly less than baseline.

Yeah after looking at it I think it's simply just asking which would be elevated in GNG. Thinking about using adipose tissue is just over thinking the question

 

[sharklasers]

Yeah after looking at it I think it's simply just asking which would be elevated in GNG. Thinking about using adipose tissue is just over thinking the question

hahah yeah i definitely did this, but i just figured you wouldn't still be doing GNG a week of starvation?

Between meals - glycogen breakdown
1-3 days without meals - GNG
3+ days without meals - ketone bodies

Thats how I learned it, and First Aid seems to confirm it, right?

I feel like some NBME questions you actually DO have to think about them hard, but others overthinking will only hurt you... now I just need to figure out how to distinguish the two lol.

 

[sharklasers]

also, with the UTI and gram + bacteria question, can't Staph also cause a UTI. according to first aid, neither Staph or Enterococcus are one of the most common causes of a UTI, so I figured they would have given a little bit more information to distinguish the two. I guessed Enterococcus and got it right... but didn't really see anything that would help me rule out staph.

Thanks!

 

[MLT2MT2DO]

also, with the UTI and gram + bacteria question, can't Staph also cause a UTI. according to first aid, neither Staph or Enterococcus are one of the most common causes of a UTI, so I figured they would have given a little bit more information to distinguish the two. I guessed Enterococcus and got it right... but didn't really see anything that would help me rule out staph.

Thanks!

Enterococcus Fecalis is endogenous in the GI tract...most of your UTIs are endogenous flora from your GI tract.

Staph CAN cause a UTI but it'd be rare

 

[doctoritis]

Alright, I'm almost embarrassed to ask but I rather take the embarrassment then screw this up on the real thing ....


The question with the newborn who presents with bilateral purulent discharge in his eyes, and giemsa stained epithelial cells that show intracytoplasmic inclusions, silver nitrate was applied at birth to both eyes.

Now I know in this case the answer was Chlamydia - because *I think* the key was the intracytoplasmic inclusion....

However, my question is, would we ever be expected to differentiate between newborn eye infections in Chlamydia and Neisseria strictly clinically without being given some external clue about the bacteria's morphology, life cycle, shape, grouping, etc???? And if so, how do you know the difference?

 

[medpack87]

Alright, I'm almost embarrassed to ask but I rather take the embarrassment then screw this up on the real thing ....


The question with the newborn who presents with bilateral purulent discharge in his eyes, and giemsa stained epithelial cells that show intracytoplasmic inclusions, silver nitrate was applied at birth to both eyes.

Now I know in this case the answer was Chlamydia - because *I think* the key was the intracytoplasmic inclusion....

However, my question is, would we ever be expected to differentiate between newborn eye infections in Chlamydia and Neisseria strictly clinically without being given some external clue about the bacteria's morphology, life cycle, shape, grouping, etc???? And if so, how do you know the difference?

I dont think so. If no other information is given regarding the clinical vignette, you just go with the most common cause. In this case, as you said, it is Chlamydia. The problem with that patient was that chlamydia is probably resistant to silver nitrate droplets.

 

[amj198]

Hey guys, this question was mentioned in an earlier post but didn't really get a good answer:
50yo male develops retinitis and endophthalmitis after 3mos of hospitalization for treatment of a chronic illness. He is receiving TPN by central venous catheter, and has been taking broad-spectrum antibiotics. Gram stain smear from blood culture is shown. This organism most likely reproduces by which of the following?
1) budding
2) endospore formation
3) hyphal fragmentation (wrong)
4) mycelia
5) ovoid conidia

They give a picture of these little things with narrow-based buds, but I don't think it's crypto because no capsule is visible. I think the picture they're showing is Candida.

 

[sharklasers]

I don't remember what the organism is but you said it yourself, you saw narrow-based buds, so the answer is budding!

 

[amj198]

Yeah I thought that might be the answer, but doesn't Candida only grow with buds at 20 degrees C? At body temperature, it's supposed to grow as germ tubes.

Also, does anyone have the answer to this?:

Does anyone remember the question about the girl having lateral neck surgery, who ends up with horner syndrome? They asked what had been damaged to cause it, and I can't figure out how one of the answers is incorrect:

The correct answer was "postsynaptic neurons from the superior cervical ganglion." Sure, that'll cause it (though I wonder what sort of neck surgery she's having done all the way up at the level of C1...)
Another answer that was supposedly incorrect was "presynaptic neurons from the stellate ganglion"

The stellate ganglion is the fusion of the inferior cervical ganglion and the first thoracic ganglion. The sympathetic fibers exiting the spinal cord must travel through the stellate ganglion before synapsing in the superior cervical ganglion, so as I understand it, damaging "presynaptic neurons from the stellate ganglion" would absolutely cause horner syndrome. Why then is that an incorrect answer?

It seems like hitting fibers from the stellate ganglion would be much more likely since the superior cervical ganglion is at C2 and the stellate ganglion is at C7. It seems much more likely to hit that if you're doing surgery on the side of the neck. Hitting C2 would mean you'd basically have to be at the edge of the kid's skull right?

 

[addo]

Yeah I thought that might be the answer, but doesn't Candida only grow with buds at 20 degrees C? At body temperature, it's supposed to grow as germ tubes.

I dont remember the picture, but I think it was cryptococcus... so itd be budding

 

[CaptainSSO]

7. Previously healthy 1.5 year old boy difficulty breathing while playing. Marked respiratory distress. Temp 37 C, respiration 70/min. Auscultation shows decreased air movement on the right, and wheezes are heard.

a. anaphylaxis
b. bronchiolitis
c. foreign body
d. pneumonia
e. spontaneous pneumothorax

Looking back I'm guessing it's foreign body aspiration, but I wouldn't expect that to cause wheezing? What exactly is causing the wheezing?

46. Wheezing again…. 6 year old coughing, wheezing, and rapid breathing for 6 hours. Diagnosed w/ upper respiratory tract infection 2 days ago. Temp 37, pulse 120, resp. 44/min, and BP 90/60. Insp/exp wheezes are heard throughout lung fields and decreased tactile fremitus.

a. asthma
b. atelectasis
c. bronchitis
d. left sided heart failure
e. pneumococcal pneumonia

And if someone could explain the decreased BP for this one I'd appreciate it.

 

[amj198]

I dont remember the picture, but I think it was cryptococcus... so itd be budding

The problem is I don't see how it could have been cryptococcus. None of the organisms had a capsule, and they were all too close together to have had a capsule and it just wasn't visible on the stain. Like they were literally all touching each other. Or am I overthinking this and it was still crypto for some reason?

 

[medpack87]

7. Previously healthy 1.5 year old boy difficulty breathing while playing. Marked respiratory distress. Temp 37 C, respiration 70/min. Auscultation shows decreased air movement on the right, and wheezes are heard.

a. anaphylaxis
b. bronchiolitis
c. foreign body
d. pneumonia
e. spontaneous pneumothorax

Looking back I'm guessing it's foreign body aspiration, but I wouldn't expect that to cause wheezing? What exactly is causing the wheezing?

46. Wheezing again…. 6 year old coughing, wheezing, and rapid breathing for 6 hours. Diagnosed w/ upper respiratory tract infection 2 days ago. Temp 37, pulse 120, resp. 44/min, and BP 90/60. Insp/exp wheezes are heard throughout lung fields and decreased tactile fremitus.

a. asthma
b. atelectasis
c. bronchitis
d. left sided heart failure
e. pneumococcal pneumonia

And if someone could explain the decreased BP for this one I'd appreciate it.

7. Foreign body. The wheezes are caused by the foreign body. Whenever you auscultate wheezes, think of an obstruction, that is the air passing through a narrowed bronchial lumen.

46. I cannot remember what I put, but I would go for asthma, because of the age and the URI that would exacerbate an asthma episode. If the patient was younger than 2 years, I would go for bronchiolitis, which is caused by RSV infection. I think his BP is normal, he is just 6 years old. Maybe on the lower end, but still normal.

 

[GTP]

Hi,

I can't seem to find answers to these questions. Any help would be greatly appreciated.

Thanks!!
1. An experiment about two enzymes. 1 vmax is 10. the other vmax is 30. what can be said about km?

A. cant be predicted based solely on vmax
B. KM will differ but cant be quantified here
C. KM for enzyme 1 is is 1/10 of enzyme 2
D. km for enzyme 1 is 10 X more than 2
E. they are the same

i now know its not B or C cuz i read the question wrong. they are two diff enzymes. is it A?


2. in a study where ala is substituted for ser, what happens to the enzyme?

A attachment of farnysel
B attachment of N linked oligosach
C formation of disulfide
D phosphorylation of enzyme
E targeting of enzyme properly

I picked E cuz i thought Ala was part of the signal sequence cuz its hydrophobic. and if its changed for ser then localization will be messed up. am i missing something here?

3. a girl who eats lots of chocolate and has acne on her forehead? wtf? i hated this question. she wears a helmet and has lots of acne. whhy does she have the acne? o shes also vegeterian

A allergy to stuff used on the road construction
B allergy to family pet
C chocolate
D excess sun exposure
E veggie diet
F wearing a helmet

i picked E cuz i really didnt know what to pick. I was on this question for 5 minutes. I picked the helmet first and then changed it. Was that the answer?

4. a man who had septic shock. he had increased cr and oliguria. he died. if he had lived, what would his kidneys look like? at autopsy, there is necrosis of many tubular cells but no damage to underlying framework or glomerli

A. diffuse renal scaring
B renal atrophy
C renal hyperplasia
D renal hypertrophy
E normal

i picked c but was wrong. was it A?

5. Some girl with ringing in her ears. There is a pick of the brainstem. I thought the answer was MLF but i was wrong. Was it vestibular nuclei and was it ipsilateral or contralateral?

6. SOmething about an ATP/mitochondrial inhibitor being applied to a single nephron. where will there be the greatest resorpption of sodium?

A. collecting duct
B DCT
C PCT
D. thick ascending loop of henle
E thin ascending
E THin descending

OMG i picked D. WAs the answer simply C? I dont think I was sane when I answered this question

7. SOmething about clamydia in mice. Why did the mouse have decreased response to clamydia pnemonia? what cell is defective?

A. B lymph
B Macs
C Neuts
D Plasma cels
E T cells

Was the answer E since clamydia is intracellular?



8. A question about HIV person with toxoplasma. How was it transfected?

A Blood transfusion
B Ingestion
C Migration across cribiform plate
D Sex
E Small droplet inhalation

Was the answer B? I remember a teacher saying preggy women shouldnt go near cat litter because they could inhale the oocysts. But in another lecture the same teacher said undercooked meat can have oocysts. I picked E and it was wrong

Thanks in advance

 

[VCorp]

Hi,

I can't seem to find answers to these questions. Any help would be greatly appreciated.

Thanks!!
1. An experiment about two enzymes. 1 vmax is 10. the other vmax is 30. what can be said about km?

A. cant be predicted based solely on vmax
B. KM will differ but cant be quantified here
C. KM for enzyme 1 is is 1/10 of enzyme 2
D. km for enzyme 1 is 10 X more than 2
E. they are the same

i now know its not B or C cuz i read the question wrong. they are two diff enzymes. is it A?
Answer is E. Can't really find a good explanation as to why its E. I thought since its measuring affinity of substrates and enzymes, you could tell, but guess not.

2. in a study where ala is substituted for ser, what happens to the enzyme?

A attachment of farnysel
B attachment of N linked oligosach
C formation of disulfide
D phosphorylation of enzyme
E targeting of enzyme properly

serine is where o-linked glycosylation occurs, in addition to threonine. Olg occurs in the Golgi apparatus. So D would be the answer. I can see why you choose E...but I don't see why that's not a good answer either.

I picked E cuz i thought Ala was part of the signal sequence cuz its hydrophobic. and if its changed for ser then localization will be messed up. am i missing something here?

3. a girl who eats lots of chocolate and has acne on her forehead? wtf? i hated this question. she wears a helmet and has lots of acne. whhy does she have the acne? o shes also vegeterian

A allergy to stuff used on the road construction
B allergy to family pet
C chocolate
D excess sun exposure
E veggie diet
F wearing a helmet

Got this wrong. I hate questions like this...I never know what's the best way of working these types of questions out. Feel like these are easy/gimme points. If I recall correctly, I think it was C.

i picked E cuz i really didnt know what to pick. I was on this question for 5 minutes. I picked the helmet first and then changed it. Was that the answer?

4. a man who had septic shock. he had increased cr and oliguria. he died. if he had lived, what would his kidneys look like? at autopsy, there is necrosis of many tubular cells but no damage to underlying framework or glomerli

A. diffuse renal scaring
B renal atrophy
C renal hyperplasia
D renal hypertrophy
E normal

i picked c but was wrong. was it A?

No. In ATN, the basement membrane is still preserved over time, and since its present the person will heal fine overtime. So E is the answer.

5. Some girl with ringing in her ears. There is a pick of the brainstem. I thought the answer was MLF but i was wrong. Was it vestibular nuclei and was it ipsilateral or contralateral?
Not sure...need more info.
6. SOmething about an ATP/mitochondrial inhibitor being applied to a single nephron. where will there be the greatest resorpption of sodium?

A. collecting duct
B DCT
C PCT
D. thick ascending loop of henle
E thin ascending
E THin descending

OMG i picked D. WAs the answer simply C? I dont think I was sane when I answered this question

Answer was C.

7. SOmething about clamydia in mice. Why did the mouse have decreased response to clamydia pnemonia? what cell is defective?

A. B lymph
B Macs
C Neuts
D Plasma cels
E T cells

Was the answer E since clamydia is intracellular?

Yup



8. A question about HIV person with toxoplasma. How was it transfected?

A Blood transfusion
B Ingestion
C Migration across cribiform plate
D Sex
E Small droplet inhalation

Was the answer B? I remember a teacher saying preggy women shouldnt go near cat litter because they could inhale the oocysts. But in another lecture the same teacher said undercooked meat can have oocysts. I picked E and it was wrong

Yup B is the right answer.

Thanks in advance

Answered. See bolded. On the iPhone... Took forever...

 

[velamj]

i put 1/(1/100) = 100 i think .....i got the 1/100 from 2.3%-1.3%=1%----> 1/1%=100...not totally sure tho can anyone confirm that? sorry forgot to quote the person who posted that.

 

[velamj]

somehow got a 233 on this. anyone heard whether this one is very indicative of how u would score? overall i thought the test was hard but more straightforward than the other ones i took, questions were very widely distributed...no heavy emphasis on one topic in particular. i thought nmbe 15 was tougher for me. some qs had some nit picky details tho

 

[GTP]

Answered. See bolded. On the iPhone... Took forever...

Thank you!

 

[jooul]

a 12 year old boy with seizure disorder is brought to the physician by his parent for a follow up examination.they show pedigree tree and then ask mode of inheritance.why answer is A when the male II-2 recevied mutation out of nowhere?(incomlete penetrance=>passing of mutation)

 

[abelabbot]

a chick aged 59 with vaginal bleeding has been off hormone replacement therapy?? is that cuz of ovarian tumor producing estrogen guys?

 

[coolcatrina]

Can someone answer these please??

Q ) The one with complement c3, segmented neutrophils, IL 1 , TNF in a rheumotoid arthritis patient

Q) A 68 year old man comes to the physician because of 1 month history of fatigue and pelvic pain that is exacerbated by movement and weight bearing activities. Vitals ar normal. Physical exam shows pale conjunctivae. There is mild pain on direct palpation of the pelvis. Lab studies show normochromic normocytic anemia and increased serum calcium ang globulin concentrations. A peripheral blood smear shows evidence of rouleauz frmation. An x ray of pelvis shows osteolytic bone lesions. A bone scan shows no abnormalties. Which is the folg is most likely diagnosis?

A ) Hyperparathyroidism
B ) Metastatic bone disease
C) Multiple myeloma
D) Osteitis deformans (pagets)
E) waldenstrom macroglobulinemia.

Smoker..which of the following mechanisms best explains how nicotine produces this sensation leading to addiciton in this patient?
A) activation of opiod receptors in midbrain
B) increased release of dopamine in nucleus accumbens
c) inhibition of GABA release in hypothalamus
D) inhibition of glutamate receptors in amygdala
E) potentiation of GABA receptors in cerebral cortx

 

[sadaca]

1) the CDs around around 20 are specificlaly B cell markers. Moreover B-ALL (95%) is far more prevalent.

2) This one is literally high school math. Sorry, I don't mean to belittle you.

if one test ("a battery of tests") has a 95% chance of being normal, being normal in three tests is 0.95 times 0.95 times 0.95

 

[sadaca]

a chick aged 59 with vaginal bleeding has been off hormone replacement therapy?? is that cuz of ovarian tumor producing estrogen guys?

0.) 50-yo man develops retinitis and endopthalmitis after 3 months of hospitalization for treatment of a chronic illness. He is receiving total parenteral nutrition by central venous catheter and has been taking broad spectrum antibiotics. A grain stain smear from blood cultures is shown. This organism most likely reproduces by which of the following?
a.) budding
b.) endospore formation
c.) hyphal fragmentation
d.)mycelia
e.) ovoid conidia

guys can someone plz explain this q it wasnt very clear..so its CMV and how does cmv reproduce? thank u so much

 

[Myxedema]

guys can someone plz explain this q it wasnt very clear..so its CMV and how does cmv reproduce? thank u so much

Based on the answer choices, it is not CMV, but a fungus. Without seeing the smear, it's not possible to definitively answer this question.

 

[medstudent987]

Hey I had some trouble with this question. Wondering if anyone knows the answer and explanation to this.

35yo woman with shortness of breath after undergoing oophorectomy. Has a large embolus in the pulmonary artery. Which of the following hemodynamic changes would you expect after lysis of the clot?

Decreased LV pressure
Decreased PV pressure
Decreased RV pressure
Increased LA pressure
Increased PA pressure
Increased RA pressure

I am stuck between the bolded answers. Any help is much appreciated! Thanks!

 

[Missorleans]

Based on the answer choices, it is not CMV, but a fungus. Without seeing the smear, it's not possible to definitively answer this question.

Pretty sure I thought it was candida, and went with budding. Didn't have this question in my extended feedback so that must have been right.

 

[medstudent987]

0.) 50-yo man develops retinitis and endopthalmitis after 3 months of hospitalization for treatment of a chronic illness. He is receiving total parenteral nutrition by central venous catheter and has been taking broad spectrum antibiotics. A grain stain smear from blood cultures is shown. This organism most likely reproduces by which of the following?
a.) budding
b.) endospore formation
c.) hyphal fragmentation
d.)mycelia
e.) ovoid conidia

guys can someone plz explain this q it wasnt very clear..so its CMV and how does cmv reproduce? thank u so much

The answer to this question was A, budding. I wasnt sure the exact organism, however, in the image provided, the organisms were forming shapes resembling "8"s or the infiniti sign, thus budding could be the only response. I just recently took this test, and got the question correct.

 

[medstudent987]

Hey I had some trouble with this question. Wondering if anyone knows the answer and explanation to this.

35yo woman with shortness of breath after undergoing oophorectomy. Has a large embolus in the pulmonary artery. Which of the following hemodynamic changes would you expect after lysis of the clot?

Decreased LV pressure
Decreased PV pressure
Decreased RV pressure
Increased LA pressure
Increased PA pressure
Increased RA pressure

I am stuck between the bolded answers. Any help is much appreciated! Thanks!

can anyone help with this?

 

[Missorleans]

RV pressure is decreased because there's no longer a clot preventing the flow of blood to the lungs, less blood backing up into the RV. Less afterload for the RV to pump against I guess is the technical term.

 

[Freddie Mercury]

1. Synovial fluid from a pt with rheumatoid arthritis would show up/down arrows: Complement, segmented neutrophils, IL1, TNF
Can someone explain this one? I saw someone earlier say dec c3 and inc everything else...but I don't understand it at all.

Skimmed through the thread but couldn't find an answer to this... the makeshift online keys say the answer is C3 DOWN... but I figured the C3 would be up. The question is referring to the synovial fluid from the affected joint, and since RA is a t3HSD, I thought there should be tons of C3 deposits there. I do agree there would be systemically lower C3, but again the question is referring to the joint fluid, not systemic blood.

 

[Didierdrogba]

Can someone please answer this? what is her condition?


A 48-year-old woman is admitted to the hospital because of 3-days history of fever and 2-weeks history of colicky lower abdominal pain. She appears pale; temp 38C; PE shows tenderness in LLQ. Lab shows normo-normo anemia and left shift leukocytosis. Tx with IV antibiotics is begun. 3-days later her fever and pain subsided and she is discharged from hospital. It is most appropiate for the physician to recommend which of the following as part of her follow-up care?

a- Avoid alcochol
b-Being using technique to stress-reducing like yoga
c- Initiate high fiber diet.
d-Join a support group with other with her condition
e-walk at least 2-miles 3 times/weekly.

 

[Missorleans]

Can someone please answer this? what is her condition?


A 48-year-old woman is admitted to the hospital because of 3-days history of fever and 2-weeks history of colicky lower abdominal pain. She appears pale; temp 38C; PE shows tenderness in LLQ. Lab shows normo-normo anemia and left shift leukocytosis. Tx with IV antibiotics is begun. 3-days later her fever and pain subsided and she is discharged from hospital. It is most appropiate for the physician to recommend which of the following as part of her follow-up care?

a- Avoid alcochol
b-Being using technique to stress-reducing like yoga
c- Initiate high fiber diet.
d-Join a support group with other with her condition
e-walk at least 2-miles 3 times/weekly.

Probably diverticulitis, answer C

 

[tantacles]

@GTP

3. a girl who eats lots of chocolate and has acne on her forehead? wtf? i hated this question. she wears a helmet and has lots of acne. whhy does she have the acne? o shes also vegeterian

A allergy to stuff used on the road construction
B allergy to family pet
C chocolate
D excess sun exposure
E veggie diet
F wearing a helmet

The answer to this one was F. The helmet is trapping stuff and leading to clogged pores. When you block a tube, you get an infection. Notice that the acne is only on her forehead.

 

[GTP]

Lol thanks. Had forgotten
all about this. Wrote step 2 yesterday.

@GTP
3. a girl who eats lots of chocolate and has acne on her forehead? wtf? i hated this question. she wears a helmet and has lots of acne. whhy does she have the acne? o shes also vegeterian

A allergy to stuff used on the road construction
B allergy to family pet
C chocolate
D excess sun exposure
E veggie diet
F wearing a helmet

The answer to this one was F. The helmet is trapping stuff and leading to clogged pores. When you block a tube, you get an infection. Notice that the acne is only on her forehead.

 

[notbobtrustme]

Skimmed through the thread but couldn't find an answer to this... the makeshift online keys say the answer is C3 DOWN... but I figured the C3 would be up. The question is referring to the synovial fluid from the affected joint, and since RA is a t3HSD, I thought there should be tons of C3 deposits there. I do agree there would be systemically lower C3, but again the question is referring to the joint fluid, not systemic blood.

someone earlier said that C3 down, neutrophils/il-1/TNF-a up, which is what I picked.

C3 would be down because it's being consumed, forming C3a and C3b.

Goljan Path -> page 643 -> dec C3 in synovium. C5a is released causing neutrophil chemotaxis, so this supports dec C3, inc neutrophils, inc IL-1, inc TNF-a.

 

[1dayatatime]

searched the thread using the search feature but didn't find this:

A 4-year-old boy has a 2-month history of easy bruisability, petechial hemorrhages, and bleeding gums. He has hepatosplenomegaly and pancytopenia. Examination of
bone marrow shows marrOW infiltration with a homogeneous population of small blast-like cells with large nuclei and scant cytoplasm. These infiltrating cells have the
following immunophenotype: CD22+, CD19+, cytoplasmic Ig~+, cytoplasmic IgK-, cytoplasmic IgA-, surface Ig-, CD3-. The patient most likely has an acute leukemia
originating from which of the following cells?
o A) Immature myelomonocytes
o B) Mature B lymphocytes
o C) Mature monocytes
o D) Mature T lymphocytes
o E) Pre-B lymphocytes
o F) Pre-T lymphocytes

the answer is E but just wanting to know why it isn't Mature B? I didn't see CALLA.

 

[notbobtrustme]

searched the thread using the search feature but didn't find this:

A 4-year-old boy has a 2-month history of easy bruisability, petechial hemorrhages, and bleeding gums. He has hepatosplenomegaly and pancytopenia. Examination of
bone marrow shows marrOW infiltration with a homogeneous population of small blast-like cells with large nuclei and scant cytoplasm. These infiltrating cells have the
following immunophenotype: CD22+, CD19+, cytoplasmic Ig~+, cytoplasmic IgK-, cytoplasmic IgA-, surface Ig-, CD3-. The patient most likely has an acute leukemia
originating from which of the following cells?
o A) Immature myelomonocytes
o B) Mature B lymphocytes
o C) Mature monocytes
o D) Mature T lymphocytes
o E) Pre-B lymphocytes
o F) Pre-T lymphocytes

the answer is E but just wanting to know why it isn't Mature B? I didn't see CALLA.

Look closely at the Igs. They have cytoplasmic Ig (eg the B-cell receptor (BCR) is being made), but no light chain, and no surface Ig (eg no BCR). That makes them immature B cells, not mature B cells. A mature B cell would be either IgK+ or IgL+ (kappa or lambda) as well as express surface Ig (eg BCR).

The other way you can solve this is young kid = ALL over CLL 99% of the time.

 

[1dayatatime]

very helpful notbob, but is ALL always PreT and PreB only? On wiki it's not really clear since there's a little chart which has pre B, pre T, and B. and omg i don't know or understand this surface ig and k and L stuff. test is in a week. ddidn't really feel like i had or have any time to review immuno