NBME 17 discussion

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
F

fatwalletuab

Full Member
15+ Year Member
Joined
Jul 22, 2008
Messages
39
Reaction score
3
Can you guys correct me on this
----------------------------------------------------------------------
8.old woman with DVT. Platelet dropped significantly after a week of tx. Drug of action?
a. activate tissue plasminogen -----action of tPA
b. Interferes with carboxylation of coag factors ----action of warfarin
c. irreversibly inactivate COX -----Aspirin
d. Potentiates the action of antithrombin iii (correct answer, action of Heparin, and this is Heparin induced Thrombocytopenia HIT)
e. selectively inhibits factor Xa (Heparin does thrombin factor 2 and factor Xa)
---------------------------------------------------------------
14.ER doctor successfully delivered a baby, womanis now having severe bleeding. Pelvic exam shows an ope cervix and heavy vaginal bleeding. Ligation of a branch of which of the following arteries is most appropriate?
a. external iliac (gives femoral and inferior epigastric artery)
b. internal iliac ( Correct answer I think, bcz Uterine artery is a branch of internal iliac artery)
c. internal pudendal (supplies the external structure, but also a branch of internal iliac)
d. median sacral (supply coccyx)
e. Obturator (gives blood supply to the leg obturator muscles)
----------------------------------------------------------------------------
16. A patient cries ad says it's a bad news, isn't it?! when a doc is about to tell him the progression of carcinoma to the terminal phase. Most appropriate response?
a. How have you been since the last time I saw you?
b. lets talk about hte positive aspect first
c. look on the bright side of things
d. tell me how you are feeling
e. there are other people who have it alot worse than you
f. Yes it is
g. you've had several years better off than many others with this disease.

I was debating on A or D. I picked D and it's wrong....is that bcz it didn't end with a question mark? wth
------------------------------------------------------------------------------------------
32. A guy with chrons disease. You give antibiotics and prednisone, he got better in 3 weeks, in addition to resolving the infection, the most likely MOA of this pharmacotherapy is which of the following?
a. antibody binding
b. complement activity
c. mast cell degranulation
e. neutrophil function
f. T-lymphocyte function

I marked e. but it's wrong....so I'm guessing T-lymphocyte fumction F? as to decrease T and B cell couns. However, neutrophil count is increased.
----------------------------------------------------------------------------------
10. 45 year old lady diagnosed with invasive ductal cell CA breast . she was started on tamoxifen and serum analysis showed decreased conc. of enoxifen the active metabolite of prodrug tamoxifen. Genetic analysis showed homozygous presence of CYP450 2D6*4 alleles. WHich of following best represents the likelihood that this patient sister has same alleles?
1.0% 2. 25% 3. 50% 4. 75% 5 100%
Can anyone solve for this one??? thanks!
--------------------------------------------
49. Old man with 2 year history of decrased force of his urinary stream and increase frequency. BUN is 55 and Creatinine is 5. Ultrasound of Urinary tract shows bilateral hydronephrosis and dilated ureters. What is the mechanism of this patient's renal failure?
a. Decreased hydrostatic pressure in the glomerular capillary
b. decreased renal plasma flow
c. Increased hydrostatic pressure in Bowman space
d. Precipitation of protein in the renal tubules
e. Precipitation of uric acid in the renal tubules
---------------------------------------------------------------------
4. A 27 yo woman with fever, malaise, abdominal pain, vaginal discharge for 4 days. Pregnancy test is negative, Leukocyte count is up. Bilateral lower quadrant tenderness with rebound and guarding. Pelvic exam shows cervical bilateral adnexal tenderness. Most likely diagnosis?
a. appendicitis
b. bacterial vaginosis
c. Chancroid
d. Diverticulitis
e. Gonorrhea
f. Herpies genitalis
g. Trichomonias

Gonorrhea...I picked chancroid on the exam...because I thought chancroid can have those bubonic thing bilaterally....i guess the answer is gonorrhea?!
-------------------------------------------
6. A study is designed to evaluate the efficacy of coenzyme Q10 in improving cardiac output in pts with CHF. 60 pts with CHF are recruited for the study. Each subject is assigned by coin toss to one of two groups (standard care or standard care plus coenzyme). Which of the following best describe this study design?
a. case-control
b. case-series
c. Crossover
d. Cross-sectional
e. Historical cohort
f. Randomized clinical-trials

I'm guessing F. is the correct answer bcz by giving q10, you're giving a treatment (intervention) to the study. And the coin toss gives the randomness.

a. Case-control: have 2 groups, one health as the control and one diseased. Trying to evaluate the risk factor. So the example will be: 60 pt with CHF drink more and smoke more. Healthy individuals smoke and drink less. Risk factors are smoking and drinking alcohols.
d. Cross-sectional: snap shot, trying to find out in a population who have CHF. You know the prevalence but not incidence.
e. I don't think it is either retrospective or prospective
----------------------------------------------------------------------
A guy completed amoxillin develop watery-brown stools in the past 24 hours. Clostridium difficile toxin is positive. Pathological finding is most likely to be present?
a. Bacterial Overgrwoth of the colonic surface
b.Flask-shaped ulcers in the colon
c. Giardia trophozoites linning the duodenal mucosa
d. Necrotizing granulomatous inflammation
e. PEsudomembranes of fibrin and inflammatory debris

They want us to pick e. But I have seen many qbank and wiki sources say a). Can someone tell me why not AAAAAAAAAAAAAAA??
---------------------------------------------------------
A 1 week old girl screening sho a possible defectin fatty acid oxidation, physical exam shows no abnormality. Which of the following is the most appropriate next step in diagnosis?
a. arterial blood gas analysis
b. measurement of serum acylcarnitine conc.
c. measurement of serum amino acid conc.
d. measurement of serum electrolyte conc.
e. measurement of serum lactic acid conc.
--------------------------------------------------------------
34. 40 yo woman has a mole on her back that has increased in size during the past 4 mo. PE shows Raise irregular lesion with variegated black-tan pigmentation and ill-defined margins. Examination of tissue from the tissue shows pleomorphic, hyperchromatic cells within clear islands that tend to coalesce and are present at all levels of the epidermis, with extension into the paipillar dermis. What is it?
a. basal cell carcinoma
b. blue nevus
c. cafe au lait spot
d. intradermal nevus
e. lentigo simplex
f. melanoma
g. seborrheic keratosis

I think it is f melanoma

-------------------------
7. A 42 year farmer has a 7mm red scaly plaque on helical rim of left ear . A photomicrograph of tissue obtained on biopsy of plaque is shown. whats the diagnosis ( Picture was shown)
a. Actinic keratosis b. Basal cell CA c. Keratocanthoma d. Malignant melanoma e. Merkel cell CA

I think it's a. actinic keratosis
Members don't see this ad.
 
Last edited:
  • Like
Reactions: 1 user
Sort by date Sort by votes
16 -F: yes it is. You have to be honest with you patient.
32- F prednisone supresses both B and T cell = decrease cytokines
 
  • Like
Reactions: 1 user
Upvote 0 Downvote
1) 25 year old female, hx of joint pain unresponsive to aspirin treatment, with bilateral swelling of proximal interphalangeal joints, metacarpophalageal joints, and the wrists; there is weakness of grasp. Small nodules palpated beneath the skin around the joints of fingers. Dx?
a) gout
b) osteoarthritis
c) RA
d) SLE [wrong]
e) systemic sclerosis

2) 15y/o girl emigrant from india, several lesions on her neck for 2 weeks. PE hypopigmented, hypoesthetic area over left side of forehead and 4cm lesions on neck. Biopsy specimen shows acid-fast bacilli. Which of the following explains why the organism results in dermal rather than in visceral infectins?
a) CO2 requirement
b) innate antibacterial compounds
c) lipid content
d) oxygen tolerance [wrong]
e) temperature sensitivity

3) Abnormal pap smear. Biopsy shows microinvasive cervial carcinoma. which of the following microscopic features led to the dx?
a) full thickness of epithelium occupied by neoplastic cells [wrong]
b) more than half of the epithelium occupide by neoplastic cells
c) neoplastic cells in sub-basement membrane connective tissue
d) neoplastic cells invading blood vessels
e) neoplastic cells invading nerves

Help me please! Thank you.
 
Upvote 0 Downvote
Members don't see this ad :)
1. RA...those nodules are classic signs
2. e. First line in FA under Tuberculosis Leprae
3. micro-invasive--(C) just pass the BM
driedfruit said:
1) 25 year old female, hx of joint pain unresponsive to aspirin treatment, with bilateral swelling of proximal interphalangeal joints, metacarpophalageal joints, and the wrists; there is weakness of grasp. Small nodules palpated beneath the skin around the joints of fingers. Dx?
a) gout
b) osteoarthritis
c) RA
d) SLE [wrong]
e) systemic sclerosis

2) 15y/o girl emigrant from india, several lesions on her neck for 2 weeks. PE hypopigmented, hypoesthetic area over left side of forehead and 4cm lesions on neck. Biopsy specimen shows acid-fast bacilli. Which of the following explains why the organism results in dermal rather than in visceral infectins?
a) CO2 requirement
b) innate antibacterial compounds
c) lipid content
d) oxygen tolerance [wrong]
e) temperature sensitivity

3) Abnormal pap smear. Biopsy shows microinvasive cervial carcinoma. which of the following microscopic features led to the dx?
a) full thickness of epithelium occupied by neoplastic cells [wrong]
b) more than half of the epithelium occupide by neoplastic cells
c) neoplastic cells in sub-basement membrane connective tissue
d) neoplastic cells invading blood vessels
e) neoplastic cells invading nerves

Help me please! Thank you.
Click to expand...
 
Upvote 0 Downvote
Thanks a lot for sharing the questions.
I did it yesterday and i still didn't check all the questions that I got wrong, but I am thinking all the time that I got right by chance. Anyone posted it yet so I was wondering if you guys know the answer so you could explain it to me....

It was sth about a guy whose house mate found him at home under a drug overdose or sth, so they were asking about how much drug did he take,
they gave you the half life 2h, they said that this happened 6h ago and they gave you more information i don't remember... i was wondering if someone know the calculations and could help me...
Thanks in advance!! :)
 
Upvote 0 Downvote
menniscus said:
Thanks a lot for sharing the questions.
I did it yesterday and i still didn't check all the questions that I got wrong, but I am thinking all the time that I got right by chance. Anyone posted it yet so I was wondering if you guys know the answer so you could explain it to me....

It was sth about a guy whose house mate found him at home under a drug overdose or sth, so they were asking about how much drug did he take,
they gave you the half life 2h, they said that this happened 6h ago and they gave you more information i don't remember... i was wondering if someone know the calculations and could help me...
Thanks in advance!! :)
Click to expand...

I believe they gave the current drug concentration. Since they give you the half life time just go backwards. If it was 10 at presentation, that means it was 20 two hours earlier, 40 four hours earlier, then 80 is the original dose 6 hours earlier.
 
  • Like
Reactions: 1 user
Upvote 0 Downvote
45 year old lady diagnosed with invasive ductal cell CA breast. She was started on tamoxifen and serum analysis showed decreased conc. of enoxifen the active metabolite of prodrug tamoxifen. Genetic analysis showed homozygous presence of CYP450 2D6*4 alleles. WHich of following best represents the likelihood that this patient sister has same alleles?
1. 0%; 2. 25%; 3. 50%; 4. 75%; 5 100%

I think I put 25%, which would be the case if each parent is a heterozygous carrier (more likely than each parent being homozygote) of the autosomal recessive allele. Can’t remember though.
------------------------------------------------------------------------------------
Old man with 2 year history of decrased force of his urinary stream and increase frequency. BUN is 55 and Creatinine is 5. Ultrasound of Urinary tract shows bilateral hydronephrosis and dilated ureters. What is the mechanism of this patient's renal failure?
a. Decreased hydrostatic pressure in the glomerular capillary
b. decreased renal plasma flow
c. Increased hydrostatic pressure in Bowman space
d. Precipitation of protein in the renal tubules
e. Precipitation of uric acid in the renal tubules

Pressure from BPH outlet obstruction is backed up all the way to the collecting system of the kidney. GFR is increased by increased hydrostatic pressure in the glomerulus (pushing filtrate thru membrane) or by increased oncotic pressure in bowman's space (filtrate is attracted to higher solute concentration across membrane). GFR is decreased by increased hydrostatic pressure in bowman's space (due to pressure increase traveling all the way up from prostate, which resists filtrate from crossing membrane) and by increased oncotic pressure in glomerulus (attracts filtrate to state in glomerulus).

Dilation of collecting system causes pressure atrophy on parenchyma and eventual kidney failure.
------------------------------------------------------------------------------------
A study is designed to evaluate the efficacy of coenzyme Q10 in improving cardiac output in pts with CHF. 60 pts with CHF are recruited for the study. Each subject is assigned by coin toss to one of two groups (standard care or standard care plus coenzyme). Which of the following best describe this study design?
a. case-control
b. case-series
c. Crossover
d. Cross-sectional
e. Historical cohort
f. Randomized clinical-trials

Definitely F. Randomization and prospective nature with treatment vs control group.
------------------------------------------------------------------------------------
A guy completed amoxillin develop watery-brown stools in the past 24 hours. Clostridium difficile toxin is positive. Pathological finding is most likely to be present?
a. Bacterial Overgrwoth of the colonic surface
b.Flask-shaped ulcers in the colon
c. Giardia trophozoites linning the duodenal mucosa
d. Necrotizing granulomatous inflammation
e. PEsudomembranes of fibrin and inflammatory debris

Bacterial overgrowth answer is less specific, and seems to suggest general multi-species bacterial overgrowth (can cause malabsorption). Also, you can have overgrowth of non-pathogenic strains of C diff according to UpToDate. I think this is why E is the best answer. If watery-brown stools are present along with toxin, the underlying pathology of pseudomembranes of fibrin and inflammatory debris is most likely to also be present.
------------------------------------------------------------------------------------
A 1 week old girl screening sho a possible defectin fatty acid oxidation, physical exam shows no abnormality. Which of the following is the most appropriate next step in diagnosis?
a. arterial blood gas analysis
b. measurement of serum acylcarnitine conc.
c. measurement of serum amino acid conc.
d. measurement of serum electrolyte conc.
e. measurement of serum lactic acid conc.

Standard test for defects in fatty acid oxidation. Can also give more specific data on type of defect.
------------------------------------------------------------------------------------
40 yo woman has a mole on her back that has increased in size during the past 4 mo. PE shows Raise irregular lesion with variegated black-tan pigmentation and ill-defined margins. Examination of tissue from the tissue shows pleomorphic, hyperchromatic cells within clear islands that tend to coalesce and are present at all levels of the epidermis, with extension into the paipillar dermis. What is it?
a. basal cell carcinoma
b. blue nevus
c. cafe au lait spot
d. intradermal nevus
e. lentigo simplex
f. melanoma
g. seborrheic keratosis

Border irregularity, Variegated black-tan color, Evolution over time are 3/5 cardinal characteristics of melanoma grossly. Histology describes melanoma.
------------------------------------------------------------------------------------
A 42 year farmer has a 7mm red scaly plaque on helical rim of left ear . A photomicrograph of tissue obtained on biopsy of plaque is shown. whats the diagnosis ( Picture was shown)
a. Actinic keratosis b. Basal cell CA c. Keratocanthoma d. Malignant melanoma e. Merkel cell CA
 
Last edited:
Upvote 0 Downvote
A 6 week old girl is brought to the physician by her mother because of 6 day history of vomitting a small amount of milk 2-3 times daily. She appears well. She is at the 50th percentile for length and weight. Physical examination shows now abnormalities. Which of the following is most likely cause of the patient’s findings.

A. Esophageal spasm
B. Gut malrotation
C. Immature lower esophageal sphincter
D. Neuromuscular abnormality of esophagus
E. Pyloric Stenosis
F. Tracheoesophageal fistula
------------------------------------------------------------------------------------
A protein found in the brown adipose tissue of mice causes a leak of H+ ions inward across inner mitochondrial membrane. Which of the following is the most likely effect of this protein on oxidative phosphorylation and energy metabolism?

A. Decreased ratio of oxygen consumption to ATP generation
B. Decreased ratio of oxygen consumption to CO2 production
C. Increased ratio of oxygen consumption to ATP generation
D. Increased ratio of oxygen consumption to CO2 production
E. No change in ratios of oxygen consumption to ATP generation and oxygen consumption to CO2 production

Oxygen still bening consumed at normal rate to create proton gradient. But some of these protons are leaking across inner mitochondrial membrane instead of passing through ATP synthase.
------------------------------------------------------------------------------------
An 80 year old woman is being evaluated for suspected temporal arteritis. Her ESR is 100mm/hr. Treatment of TA involves the use of glucocorticoids, which could have serious adverse effects. The pretest probability for TA is 50% in this patient. In evaluation of TA, ESR has sensitivity of 99%, and a specificity of 60%. Based on the results of the ESR testing in this patient, which of the following is the most appropriate step in management?

A. Additional testing to confirm dx of TA
B. Corticosteroid therapy, since the diagnosis of TA has been established with 99% certainty
C. Elimination of TA from further diagnostic consideration
D. Repeat ESR; if again positive, corticosteroid therapy
E. Repeat ESR; if normal, additional testing to confirm diagnosis of TA

Whats the answer here? Additional testing (biopsy)? UpToDate indicates biopsy is necessary, but with pretest probability of 50% it seems like you would want to go ahead and treat to prevent vision loss.
 
  • Like
Reactions: 1 user
Upvote 0 Downvote
rplee said:
An 80 year old woman is being evaluated for suspected temporal arteritis. Her ESR is 100mm/hr. Treatment of TA involves the use of glucocorticoids, which could have serious adverse effects. The pretest probability for TA is 50% in this patient. In evaluation of TA, ESR has sensitivity of 99%, and a specificity of 60%. Based on the results of the ESR testing in this patient, which of the following is the most appropriate step in management?

A. Additional testing to confirm dx of TA
B. Corticosteroid therapy, since the diagnosis of TA has been established with 99% certainty
C. Elimination of TA from further diagnostic consideration
D. Repeat ESR; if again positive, corticosteroid therapy
E. Repeat ESR; if normal, additional testing to confirm diagnosis of TA

Whats the answer here? Additional testing (biopsy)? UpToDate indicates biopsy is necessary, but with pretest probability of 50% it seems like you would want to go ahead and treat to prevent vision loss.
Click to expand...
I would go with D as it is minimally invasive, does not significantly delay care, and (if negative) can preclude adverse reactions to unnecessary corticosteroid therapy. A, B, C, and E are definitely wrong.
 
Last edited:
  • Like
Reactions: 1 user
Upvote 0 Downvote
rplee said:
An 80 year old woman is being evaluated for suspected temporal arteritis. Her ESR is 100mm/hr. Treatment of TA involves the use of glucocorticoids, which could have serious adverse effects. The pretest probability for TA is 50% in this patient. In evaluation of TA, ESR has sensitivity of 99%, and a specificity of 60%. Based on the results of the ESR testing in this patient, which of the following is the most appropriate step in management?

A. Additional testing to confirm dx of TA
B. Corticosteroid therapy, since the diagnosis of TA has been established with 99% certainty
C. Elimination of TA from further diagnostic consideration
D. Repeat ESR; if again positive, corticosteroid therapy
E. Repeat ESR; if normal, additional testing to confirm diagnosis of TA

Whats the answer here? Additional testing (biopsy)? UpToDate indicates biopsy is necessary, but with pretest probability of 50% it seems like you would want to go ahead and treat to prevent vision loss.
Click to expand...

I think the most right answer is A, going for biopsy +/- CRP. It's extremely unlikely that ESR would be falsely elevated as high as 100, and it commonly reaches levels that high in TA. So a repeat ESR would be useless acutely, IMO. I think they are trying to get at something with the stats here, as the post-test probability is ~71%, but I don't know what that means as far as next best step. The best answer would be B if not for the 99% certainty part, because you would want to treat empirically while waiting on biopsy results to reduce risk of permanent vision loss. I don't see repeating an ESR as beneficial as you would still have the same rate of false positives if you thought 100 could possibly be a false positive.
 
  • Like
Reactions: 2 users
Upvote 0 Downvote
An 83-year-old man is brought to the emergency department after being found at home bedridden and confused. He takes no medications. Temperature is 35.6°C (96°F), pulse is 100/min, and blood pressure is 85/50 mm Hg. Blood pressure is unchanged after intravenous infusion of 1 liter of isotonic saline. A pulmonary artery catheter is inserted and the following findings are obtained:

Cardiac output high

Pulmonary capillary wedge pressure low

Systemic vascular resistance low


Which of the following is the most likely cause of the hypotension?



A) Early septic shock


B) Gastrointestinal bleeding


C) Hypothyroidism


D) Massive pulmonary embolism (Wrong)


E) Silent myocardial infarction


Since no effect from NaCl, and we have systolic dysfunction, answer is MI ?
 
Upvote 0 Downvote
fatwalletuab said:
1. RA...those nodules are classic signs
2. e. First line in FA under Tuberculosis Leprae
3. micro-invasive--(C) just pass the BM
Click to expand...

microinvasive cancer as any lesion in which neoplastic cells invade the stroma, in one or more sites, to a depth of ≤3 mm below the base of the epithelium, without lymphatic or blood vessel involvement
 
Upvote 0 Downvote
An 83-year-old man is brought to the emergency department after being found at home bedridden and confused. He takes no medications. Temperature is 35.6°C (96°F), pulse is 100/min, and blood pressure is 85/50 mm Hg. Blood pressure is unchanged after intravenous infusion of 1 liter of isotonic saline. A pulmonary artery catheter is inserted and the following findings are obtained:

Cardiac output high
Pulmonary capillary wedge pressure low
Systemic vascular resistance low

Which of the following is the most likely cause of the hypotension?

A) Early septic shock
B) Gastrointestinal bleeding
C) Hypothyroidism
D) Massive pulmonary embolism (Wrong)
E) Silent myocardial infarction

Since no effect from NaCl, and we have systolic dysfunction, answer is MI ?

--> I think the answer is (A) early septic shock for this one. Elderly patients can have low temperature in septic shock. Patient is also delirious which points toward infection.
--> Low systemic vascular resistance rules out GI bleed. Cardiac output would be low if silent MI causing such a low drop in BP, and PCWP would be high due to pulmonary congestion behind failing left heart. Hypothyroidism...no.
 
  • Like
Reactions: 1 users
Upvote 0 Downvote
Members don't see this ad :)
rplee said:
An 83-year-old man is brought to the emergency department after being found at home bedridden and confused. He takes no medications. Temperature is 35.6°C (96°F), pulse is 100/min, and blood pressure is 85/50 mm Hg. Blood pressure is unchanged after intravenous infusion of 1 liter of isotonic saline. A pulmonary artery catheter is inserted and the following findings are obtained:

Cardiac output high
Pulmonary capillary wedge pressure low
Systemic vascular resistance low

Which of the following is the most likely cause of the hypotension?

A) Early septic shock
B) Gastrointestinal bleeding
C) Hypothyroidism
D) Massive pulmonary embolism (Wrong)
E) Silent myocardial infarction

Since no effect from NaCl, and we have systolic dysfunction, answer is MI ?

--> I think the answer is (A) early septic shock for this one. Elderly patients can have low temperature in septic shock. Patient is also delirious which points toward infection.
--> Low systemic vascular resistance rules out GI bleed. Cardiac output would be low if silent MI causing such a low drop in BP, and PCWP would be high due to pulmonary congestion behind failing left heart. Hypothyroidism...no.
Click to expand...

Thanks!
 
Upvote 0 Downvote
pd1112 said:
I think the most right answer is A, going for biopsy +/- CRP. It's extremely unlikely that ESR would be falsely elevated as high as 100, and it commonly reaches levels that high in TA. So a repeat ESR would be useless acutely, IMO. I think they are trying to get at something with the stats here, as the post-test probability is ~71%, but I don't know what that means as far as next best step. The best answer would be B if not for the 99% certainty part, because you would want to treat empirically while waiting on biopsy results to reduce risk of permanent vision loss. I don't see repeating an ESR as beneficial as you would still have the same rate of false positives if you thought 100 could possibly be a false positive.
Click to expand...
Steroid therapy should never be delayed for biopsy if temporal arteritis is strongly suspected (and really, you wouldn't be doing a biopsy anyway if you didn't strongly suspect it). The biopsy itself is notorious for false negative results and often requires multiple harvests.

I would agree with the logic of starting steroid therapy immediately, but as you pointed out the "99% certainty" part is inaccurate.

Replicating test results to guide medical decision making is a well known strategy with mixed scientific validity. I wouldn't say that it is the most correct answer, but it's definitely the least incorrect one.
 
  • Like
Reactions: 1 user
Upvote 0 Downvote
I put D (Repeat ESR; if again positive, corticosteroid therapy) and it was wrong. That leaves A or E.

Since sensitivity of ESR is 99% for temporal arteritis, a negative on the repeat would essentially rule out that diagnosis, and there would be no reason for running "additional testing to confirm TA".

I agree that A is most right but don't love it.
 
Upvote 0 Downvote
Has to be A then. An ESR of 100 is extremely unlikely to be a false negative, so I don't think repeating it would be beneficial. You probably would order CRP, CBC, and biopsy, and treat if you see elevated CRP, normocytic normochromic anemia and thrombocytosis, while waiting for biopsy results.

As I mentioned before, I think they are going more for the stats in this question than expecting us to know specific MDM required for TA, especially without giving us H&P. So from a stats perspective, with 50% pretest probability and only 60% specificity, I think they would expect more tests for confirmation.
 
  • Like
Reactions: 1 users
Upvote 0 Downvote
Got more questions, would appreciate some help.
1. Female pt w/ mt breast cancer, transferred to an hospice. Only family member are allowed to stay after visiting hours. Most appropiate response by the physician?
2. Pt w/ alcohol-induced liver diasease develops ascites, treated with loop diuretics and what else? acetazolamide? Hydrochlorothiazide? Indapamide? Metolazone? Spironolactone?
3. (Long DNA sequence) A mutation from g to a most likely to lead to Beta thalaseemia by which mec? missense mut leads to defective b globin? (wrong).... disruption of normal splicing by creation of ne 3' splice site? Disruption of polyadenylation of the mRNA? Inhibition of replication of this gene?
4. 56yo man w/ sudden onset of uncontrollable mov of the left side of the body (proximal). Damaged nuclei? Left: caudate? dentate? subthalamic? Righ: Caudate? dentate? subthalamic? (I suck at neuro)
5. after a motor vehicle collision, Pt with complete paralysis of the left lower extremity, fx right mid humerus (damaged radial n), fx of the right tibia, casts on both fxs, after 10 weeks deep tendon reflex are strongest in which location? left achilles tendon? left biceps tendon? right brachioradialis tendon? (i'm thinking is this)... right patellar?
6. Crazy biostat qs with a graph, pts receiving injection of lidocaine... answers: placebo effect? (is it this?) ... regression to the mean? selection bias? typpe II error? uncontrolled confounding?


Please heeeelp... I can answer some questions too!

Thanks!
 
Last edited:
Upvote 0 Downvote
fatwalletuab said:
Can you guys correct me on this
----------------------------------------------------------------------
8.old woman with DVT. Platelet dropped significantly after a week of tx. Drug of action?
a. activate tissue plasminogen -----action of tPA
b. Interferes with carboxylation of coag factors ----action of warfarin
c. irreversibly inactivate COX -----Aspirin
d. Potentiates the action of antithrombin iii (correct answer, action of Heparin, and this is Heparin induced Thrombocytopenia HIT)
e. selectively inhibits factor Xa (Heparin does thrombin factor 2 and factor Xa)
---------------------------------------------------------------
14.ER doctor successfully delivered a baby, womanis now having severe bleeding. Pelvic exam shows an ope cervix and heavy vaginal bleeding. Ligation of a branch of which of the following arteries is most appropriate?
a. external iliac (gives femoral and inferior epigastric artery)
b. internal iliac ( Correct answer I think, bcz Uterine artery is a branch of internal iliac artery)
c. internal pudendal (supplies the external structure, but also a branch of internal iliac)
d. median sacral (supply coccyx)
e. Obturator (gives blood supply to the leg obturator muscles)
----------------------------------------------------------------------------
16. A patient cries ad says it's a bad news, isn't it?! when a doc is about to tell him the progression of carcinoma to the terminal phase. Most appropriate response?
a. How have you been since the last time I saw you?
b. lets talk about hte positive aspect first
c. look on the bright side of things
d. tell me how you are feeling
e. there are other people who have it alot worse than you
f. Yes it is (THIS IS CORRECT)
g. you've had several years better off than many others with this disease.

I was debating on A or D. I picked D and it's wrong....is that bcz it didn't end with a question mark? wth
------------------------------------------------------------------------------------------
32. A guy with chrons disease. You give antibiotics and prednisone, he got better in 3 weeks, in addition to resolving the infection, the most likely MOA of this pharmacotherapy is which of the following?
a. antibody binding
b. complement activity
c. mast cell degranulation
e. neutrophil function
f. T-lymphocyte function (THIS IS CORRECT)

I marked e. but it's wrong....so I'm guessing T-lymphocyte fumction F? as to decrease T and B cell couns. However, neutrophil count is increased.
----------------------------------------------------------------------------------
10. 45 year old lady diagnosed with invasive ductal cell CA breast . she was started on tamoxifen and serum analysis showed decreased conc. of enoxifen the active metabolite of prodrug tamoxifen. Genetic analysis showed homozygous presence of CYP450 2D6*4 alleles. WHich of following best represents the likelihood that this patient sister has same alleles?
1.0% 2. 25% (THIS IS CORRECT) 3. 50% 4. 75% 5 100%
Can anyone solve for this one??? thanks!
--------------------------------------------
49. Old man with 2 year history of decrased force of his urinary stream and increase frequency. BUN is 55 and Creatinine is 5. Ultrasound of Urinary tract shows bilateral hydronephrosis and dilated ureters. What is the mechanism of this patient's renal failure?
a. Decreased hydrostatic pressure in the glomerular capillary
b. decreased renal plasma flow
c. Increased hydrostatic pressure in Bowman space (THIS IS CORRECT)
d. Precipitation of protein in the renal tubules
e. Precipitation of uric acid in the renal tubules
---------------------------------------------------------------------
4. A 27 yo woman with fever, malaise, abdominal pain, vaginal discharge for 4 days. Pregnancy test is negative, Leukocyte count is up. Bilateral lower quadrant tenderness with rebound and guarding. Pelvic exam shows cervical bilateral adnexal tenderness. Most likely diagnosis?
a. appendicitis
b. bacterial vaginosis
c. Chancroid
d. Diverticulitis
e. Gonorrhea (THIS IS CORRECT)
f. Herpies genitalis
g. Trichomonias

Gonorrhea...I picked chancroid on the exam...because I thought chancroid can have those bubonic thing bilaterally....i guess the answer is gonorrhea?!
-------------------------------------------
6. A study is designed to evaluate the efficacy of coenzyme Q10 in improving cardiac output in pts with CHF. 60 pts with CHF are recruited for the study. Each subject is assigned by coin toss to one of two groups (standard care or standard care plus coenzyme). Which of the following best describe this study design?
a. case-control
b. case-series
c. Crossover
d. Cross-sectional
e. Historical cohort
f. Randomized clinical-trials (THIS IS CORRECT)

I'm guessing F. is the correct answer bcz by giving q10, you're giving a treatment (intervention) to the study. And the coin toss gives the randomness.

a. Case-control: have 2 groups, one health as the control and one diseased. Trying to evaluate the risk factor. So the example will be: 60 pt with CHF drink more and smoke more. Healthy individuals smoke and drink less. Risk factors are smoking and drinking alcohols.
d. Cross-sectional: snap shot, trying to find out in a population who have CHF. You know the prevalence but not incidence.
e. I don't think it is either retrospective or prospective
----------------------------------------------------------------------
A guy completed amoxillin develop watery-brown stools in the past 24 hours. Clostridium difficile toxin is positive. Pathological finding is most likely to be present?
a. Bacterial Overgrwoth of the colonic surface
b.Flask-shaped ulcers in the colon THIS IS E. hystolitica
c. Giardia trophozoites linning the duodenal mucosa
d. Necrotizing granulomatous inflammation
e. PEsudomembranes of fibrin and inflammatory debris (THIS IS CORRECT)

They want us to pick e. But I have seen many qbank and wiki sources say a). Can someone tell me why not AAAAAAAAAAAAAAA??
---------------------------------------------------------
A 1 week old girl screening sho a possible defectin fatty acid oxidation, physical exam shows no abnormality. Which of the following is the most appropriate next step in diagnosis?
a. arterial blood gas analysis
b. measurement of serum acylcarnitine conc. (THIS IS CORRECT)
c. measurement of serum amino acid conc.
d. measurement of serum electrolyte conc.
e. measurement of serum lactic acid conc.
--------------------------------------------------------------
34. 40 yo woman has a mole on her back that has increased in size during the past 4 mo. PE shows Raise irregular lesion with variegated black-tan pigmentation and ill-defined margins. Examination of tissue from the tissue shows pleomorphic, hyperchromatic cells within clear islands that tend to coalesce and are present at all levels of the epidermis, with extension into the paipillar dermis. What is it?
a. basal cell carcinoma
b. blue nevus
c. cafe au lait spot
d. intradermal nevus
e. lentigo simplex
f. melanoma (THIS IS CORRECT)
g. seborrheic keratosis

I think it is f melanoma

-------------------------
7. A 42 year farmer has a 7mm red scaly plaque on helical rim of left ear . A photomicrograph of tissue obtained on biopsy of plaque is shown. whats the diagnosis ( Picture was shown)
a. Actinic keratosis (THIS IS CORRECT) . Basal cell CA c. Keratocanthoma d. Malignant melanoma e. Merkel cell CA

I think it's a. actinic keratosis
Click to expand...
 
Upvote 0 Downvote
10 y/o, her mom wants to know when she will begin puberty. Doc says the following is the first objective sign of puberty:
a) breast bud development
b) dev of axillary hair
c) dev of pubic hair (WRONG)
d) onset of menses
e) rapidly increasing height

thought it might be (a) or maybe if objective was the key word here then (d)??

Thanks
 
Upvote 0 Downvote
1. Female pt w/ mt breast cancer, transferred to an hospice. Only family member are allowed to stay after visiting hours. Most appropriate response by the physician?
--> You seem very important to each other, you can stay...

2. Pt w/ alcohol-induced liver diasease develops ascites, treated with loop diuretics and what else? acetazolamide? Hydrochlorothiazide? Indapamide? Metolazone? Spironolactone?
--> Spironolactone to mitigate K wasting.

3. (Long DNA sequence) A mutation from g to a most likely to lead to Beta thalaseemia by which mec? missense mut leads to defective b globin? (wrong).... disruption of normal splicing by creation of ne 3' splice site? Disruption of polyadenylation of the mRNA? Inhibition of replication of this gene?
--> Disruption of splicing (Beta thal mutations are usually promoter or splice site mutations.

4. 56yo man w/ sudden onset of uncontrollable mov of the left side of the body (proximal). Damaged nuclei? Left: caudate? dentate? subthalamic? Righ: Caudate? dentate? subthalamic? (I suck at neuro)
--> Lesion to contralateral Subthalamic Nucleus causes hemiballismus

5. after a motor vehicle collision, Pt with complete paralysis of the left lower extremity, fx right mid humerus (damaged radial n), fx of the right tibia, casts on both fxs, after 10 weeks deep tendon reflex are strongest in which location? left achilles tendon? left biceps tendon? right brachioradialis tendon? (i'm thinking is this)... right patellar?
--> I think it was the location affected by an upper motor neuron lesion (which would cause hyperreflexia). Left achilles?

6. Crazy biostat qs with a graph, pts receiving injection of lidocaine... answers: placebo effect? (is it this?) ... regression to the mean? selection bias? typpe II error? uncontrolled confounding?
--> I think placebo effect. If I remember correctly they were still getting pain relief from placebo injection.

10 y/o, her mom wants to know when she will begin puberty. Doc says the following is the first objective sign of puberty:
a) breast bud development
b) dev of axillary hair
c) dev of pubic hair (WRONG)
d) onset of menses
e) rapidly increasing height
 
  • Like
Reactions: 1 users
Upvote 0 Downvote
medrocks1 said:
)
5. after a motor vehicle collision, Pt with complete paralysis of the left lower extremity, fx right mid humerus (damaged radial n), fx of the right tibia, casts on both fxs, after 10 weeks deep tendon reflex are strongest in which location? left achilles tendon? left biceps tendon? right brachioradialis tendon? (i'm thinking is this)... right patellar?
Click to expand...

rplee said:
5. after a motor vehicle collision, Pt with complete paralysis of the left lower extremity, fx right mid humerus (damaged radial n), fx of the right tibia, casts on both fxs, after 10 weeks deep tendon reflex are strongest in which location? left achilles tendon? left biceps tendon? right brachioradialis tendon? (i'm thinking is this)... right patellar?
--> I think it was the location affected by an upper motor neuron lesion (which would cause hyperreflexia). Left achilles?
Click to expand...

Pt has complete paralysis of LLE, meaning spinal cord injury on the left at L2. The right sided fractures would be LMN lesions causing hyporeflexia/areflexia, so cross off those two. Left biceps should be normal ~ 2+. The key is "after 10 weeks," which means he should have recovered from spinal shock (during which left achilles reflex would be minimal). After recovering from spinal shock, reflexes become very hyperreflexive, so left achilles should be correct.
 
  • Like
Reactions: 4 users
Upvote 0 Downvote
pd1112 said:
Pt has complete paralysis of LLE, meaning spinal cord injury on the left at L2. The right sided fractures would be LMN lesions causing hyporeflexia/areflexia, so cross off those two. Left biceps should be normal ~ 2+. The key is "after 10 weeks," which means he should have recovered from spinal shock (during which left achilles reflex would be minimal). After recovering from spinal shock, reflexes become very hyperreflexive, so left achilles should be correct.
Click to expand...



Thanks a lot... that makes a lot of sense!!!
 
Upvote 0 Downvote
rplee said:
1. Female pt w/ mt breast cancer, transferred to an hospice. Only family member are allowed to stay after visiting hours. Most appropriate response by the physician?
--> You seem very important to each other, you can stay...

2. Pt w/ alcohol-induced liver diasease develops ascites, treated with loop diuretics and what else? acetazolamide? Hydrochlorothiazide? Indapamide? Metolazone? Spironolactone?
--> Spironolactone to mitigate K wasting.

3. (Long DNA sequence) A mutation from g to a most likely to lead to Beta thalaseemia by which mec? missense mut leads to defective b globin? (wrong).... disruption of normal splicing by creation of ne 3' splice site? Disruption of polyadenylation of the mRNA? Inhibition of replication of this gene?
--> Disruption of splicing (Beta thal mutations are usually promoter or splice site mutations.

4. 56yo man w/ sudden onset of uncontrollable mov of the left side of the body (proximal). Damaged nuclei? Left: caudate? dentate? subthalamic? Righ: Caudate? dentate? subthalamic? (I suck at neuro)
--> Lesion to contralateral Subthalamic Nucleus causes hemiballismus

5. after a motor vehicle collision, Pt with complete paralysis of the left lower extremity, fx right mid humerus (damaged radial n), fx of the right tibia, casts on both fxs, after 10 weeks deep tendon reflex are strongest in which location? left achilles tendon? left biceps tendon? right brachioradialis tendon? (i'm thinking is this)... right patellar?
--> I think it was the location affected by an upper motor neuron lesion (which would cause hyperreflexia). Left achilles?

6. Crazy biostat qs with a graph, pts receiving injection of lidocaine... answers: placebo effect? (is it this?) ... regression to the mean? selection bias? typpe II error? uncontrolled confounding?
--> I think placebo effect. If I remember correctly they were still getting pain relief from placebo injection.

10 y/o, her mom wants to know when she will begin puberty. Doc says the following is the first objective sign of puberty:
a) breast bud development
b) dev of axillary hair
c) dev of pubic hair (WRONG)
d) onset of menses
e) rapidly increasing height
Click to expand...



Thanks a lot! great help!
 
Upvote 0 Downvote
Did someone get the Q about a drug intoxication (6 hs before), with blood drug concentration 0.3 mg/L, Vd 200L, T1/2 2 hs right?
 
Upvote 0 Downvote
12 yr old boy swimming in moutain stream. Immersed up to his neck in 60 degree farenheit water for 20 minutes. what changes occur (up/down) for central blood volume, ADH, and ANP.

Can someone help me reason out this question/answer? Thanks!
 
Upvote 0 Downvote
eirrac said:
12 yr old boy swimming in moutain stream. Immersed up to his neck in 60 degree farenheit water for 20 minutes. what changes occur (up/down) for central blood volume, ADH, and ANP.

Can someone help me reason out this question/answer? Thanks!
Click to expand...

--> My reasoning was this: (1) To prevent heat loss, peripheral vessels are constricted, increasing central blood volume. (2) Incr central blood volume would inhibit ADH release, so as not to further increase volume. (3) Incr central volume stimulates the atria to release ANP, which promotes diuresis and relaxes systemic vascular resistance.
--------------------
medrocks1 said:
Did someone get the Q about a drug intoxication (6 hs before), with blood drug concentration 0.3 mg/L, Vd 200L, T1/2 2 hs right?
Click to expand...

--> I can't remember the exact question, but I think it asked about amount of drug administered/taken 6 hours before...
--> If the half life is two hours, the concentration 2 hours ago would have been 0.6mg/L, 4 hours ago 1.2mg/L, and 6 hours ago 2.4mg/L.
--> To achieve a concentration of 2.4mg/L with a Vd of 200L, you would need to administer 2.4 mg/L x 200 L = 480 mg. Sound right?
 
Last edited:
  • Like
Reactions: 2 users
Upvote 0 Downvote
I think this explanation works for a zero-order-kinetics but this drug has first-order one-compartment kinetics, which I have not heard before or is a bit difficult for me to understand. Perhaps it takes to understand first-order one-compartment kinetics. Anyone with a neat explanation? please help. thanks!
 
Upvote 0 Downvote
rplee said:
--> My reasoning was this: (1) To prevent heat loss, peripheral vessels are constricted, increasing central blood volume. (2) Incr central blood volume would inhibit ADH release, so as not to further increase volume. (3) Incr central volume stimulates the atria to release ANP, which promotes diuresis and relaxes systemic vascular resistance.
--------------------


--> I can't remember the exact question, but I think it asked about amount of drug administered/taken 6 hours before...
--> If the half life is two hours, the concentration 2 hours ago would have been 0.6mg/L, 4 hours ago 1.2mg/L, and 6 hours ago 2.4mg/L.
--> To achieve a concentration of 2.4mg/L with a Vd of 200L, you would need to administer 2.4 mg/L x 200 L = 480 mg. Sound right?
Click to expand...

I think this explanation works for a zero-order-kinetics but this drug has first-order one-compartment kinetics, which I have not heard before or is a bit difficult for me to understand. Perhaps it takes to understand first-order one-compartment kinetics. Anyone with a neat explanation? please help. thanks!
 
Upvote 0 Downvote
Charmer said:
I think this explanation works for a zero-order-kinetics but this drug has first-order one-compartment kinetics, which I have not heard before or is a bit difficult for me to understand. Perhaps it takes to understand first-order one-compartment kinetics. Anyone with a neat explanation? please help. thanks!
Click to expand...

Oh my word! I think I see what rplee is meaning, That is superb. I think i was just an over thinker here and I couldn't figure it out right. After all that explanation is not a reflection of zero order kinetics. It is pure first order. Thanks. How I wish I could stop myself from overthinking!
 
Upvote 0 Downvote
Can you help me in sorting this qstn. ?

60 y.o.m- for examn. prior to employment. P/E- NAD
Lab- Hgb-14g/dl, Hct-42% Leukoctes- 12K/mm3 (segmented N-45%, small L- 50%, monocytes 5%), Plt. 250K/mm3.
Flow cytometry- CD3-50%, CD4-40%, CD8-10%, CD20-50%, surface kappa-47%, surface lambda-3%

Most predictive of clonal Lymphoid proliferation in this pt.

A) Absolute cd3+ T-lym. # (not)
B) Absolute cd20+ B-lym. # (not)
C) Absolute lym. #
D) CD4: CD8 ratio
E) surface kappa: lambda ratio (highly suspect this one but something in my mind is not taking me for granted)

Absolute Lym. #- may not necessarily reflect clonality as it can also be seen in reactive Lymphoid reaction for various infecn. and it usually is polyclonal.

CD4: CD8 ratio is an overall assessment for immune status ( more of something like an objective analysis like how we do for PT/PTT ratio (INR) to see coagulation abs.)

That leaves me with the last option and I somehow know for t-lym it is analysis of the TCR (T-cell receptor) monoclonalty and, for b-lym, Ig- variable region monoclonalty confirmation which helps to conclude clonal expansion. But I can't see how to add up any of these choices to this. I ain't getting it. Can you guys help and explain? Thanks in advance!
 
Last edited:
Upvote 0 Downvote
pd1112 said:
Pt has complete paralysis of LLE, meaning spinal cord injury on the left at L2. The right sided fractures would be LMN lesions causing hyporeflexia/areflexia, so cross off those two. Left biceps should be normal ~ 2+. The key is "after 10 weeks," which means he should have recovered from spinal shock (during which left achilles reflex would be minimal). After recovering from spinal shock, reflexes become very hyperreflexive, so left achilles should be correct.
Click to expand...

not that anything you said is wrong but :p the question wasn't written like its on the nbme :p

A 19-year-old man is admitted to the hospital following a motor vehicle collision. Physical examination shows a penetrating wound to the right cerebral cortex with complete paralysis of the left lower extremity, fracture of the right mid humerus with severing of the radial nerve, and a fracture of the right tibia. Treatment includes cast immobilization of the right upper extremity and right knee and ankle. After 10 weeks, the casts are scheduled to be removed from the right upper and lower extremities. At this point, the deep tendon reflex is most likely to be strongest in which of the following locations in this patient?

so no spinal cord lesion .

Charmer said:
Can you help me in sorting this qstn. ?

60 y.o.m- for examn. prior to employment. P/E- NAD
Lab- Hgb-14g/dl, Hct-42% Leukoctes- 12K/mm3 (segmented N-45%, small L- 50%, monocytes 5%), Plt. 250K/mm3.
Flow cytometry- CD3-50%, CD4-40%, CD8-10%, CD20-50%, surface kappa-47%, surface lambda-3%

Most predictive of clonal Lymphoid proliferation in this pt.

A) Absolute cd3+ T-lym. # (not)
B) Absolute cd20+ B-lym. # (not)
C) Absolute lym. #
D) CD4: CD8 ratio
E) surface kappa: lambda ratio (highly suspect this one but something in my mind is not taking me for granted)

Absolute Lym. #- may not necessarily reflect clonality as it can also be seen in reactive Lymphoid reaction for various infecn. and it usually is polyclonal.

CD4: CD8 ratio is an overall assessment for immune status ( more of something like an objective analysis like how we do for PT/PTT ratio (INR) to see coagulation abs.)

That leaves me with the last option and I somehow know for t-lym it is analysis of the TCR (T-cell receptor) monoclonalty and, for b-lym, Ig- variable region monoclonalty confirmation which helps to conclude clonal expansion. But I can't see how to add up any of these choices to this. I ain't getting it. Can you guys help and explain? Thanks in advance!
Click to expand...

and what you suspected was right :p it surface kappa ( i forgot the exact number but the ratio of kappa and lamda its like 1/2 or 1/3 forgot which one it favors, i think lamdbda (ill redo that part on pathoma he explains it very well) so when you see one of either so out of proportion its its a clonal expansion.
the other thing that makes me think that reasoning is right ( other than me getting it right on the nbme) was that you can get absolute cd3 t cells number or cd20 Bcells
any or cd4:cd8 ratio screwed up in any other scenario like infection (HIV CD4:CD8), dgeorge would have absolute B cell count. Hope what i said makes sense and it wasn't all wrong lol first time post something.
 
  • Like
Reactions: 1 user
Upvote 0 Downvote
Bbot said:
not that anything you said is wrong but :p the question wasn't written like its on the nbme :p

A 19-year-old man is admitted to the hospital following a motor vehicle collision. Physical examination shows a penetrating wound to the right cerebral cortex with complete paralysis of the left lower extremity, fracture of the right mid humerus with severing of the radial nerve, and a fracture of the right tibia. Treatment includes cast immobilization of the right upper extremity and right knee and ankle. After 10 weeks, the casts are scheduled to be removed from the right upper and lower extremities. At this point, the deep tendon reflex is most likely to be strongest in which of the following locations in this patient?

so no spinal cord lesion
Click to expand...

Thanks, whoever posted the Q left out that part so I assumed spinal cord injury. The way it's actually written makes the answer very easy.
 
Upvote 0 Downvote
and what you suspected was right :p it surface kappa ( i forgot the exact number but the ratio of kappa and lamda its like 1/2 or 1/3 forgot which one it favors, i think lamdbda (ill redo that part on pathoma he explains it very well) so when you see one of either so out of proportion its its a clonal expansion.
the other thing that makes me think that reasoning is right ( other than me getting it right on the nbme) was that you can get absolute cd3 t cells number or cd20 Bcells
any or cd4:cd8 ratio screwed up in any other scenario like infection (HIV CD4:CD8), dgeorge would have absolute B cell count. Hope what i said makes sense and it wasn't all wrong lol first time post something.[/QUOTE]


thanks :p
 
Last edited:
Upvote 0 Downvote
pd1112 said:
Has to be A then. An ESR of 100 is extremely unlikely to be a false negative, so I don't think repeating it would be beneficial. You probably would order CRP, CBC, and biopsy, and treat if you see elevated CRP, normocytic normochromic anemia and thrombocytosis, while waiting for biopsy results.

As I mentioned before, I think they are going more for the stats in this question than expecting us to know specific MDM required for TA, especially without giving us H&P. So from a stats perspective, with 50% pretest probability and only 60% specificity, I think they would expect more tests for confirmation.
Click to expand...

Yeah it was A. There is no need to retest when using a highly sensitive / low spec test. It is only to rule things in and get you thinking about them. Many disorders can cause high ESR so retesting and getting another high ESR wouldn't be useful. Doing a biopsy (specific) and seeing the features of TA will help you.

Anyone know about the question with the 70 year old who dies in a motor collision. He had been undergoing eval for occult blood in the stool. Transection of the transverse colon at autopsy shows one polyp (picture shown).

A) hyperplastic (wrong)
B) inflammatory psuedopolyp
C) juvenile
D) peutz Jegher
E) tubular adenoma

I guess it was tubular adenoma but why / what where they getting at? I thought you couldn't tell if it was hyperplastic vs adenoma grossly which is why you have to biopsy. Both can bleed... and hyperplastic is the most common polyp which is why I chose A.
 
Upvote 0 Downvote
shouldigomd said:
Yeah it was A. There is no need to retest when using a highly sensitive / low spec test. It is only to rule things in and get you thinking about them. Many disorders can cause high ESR so retesting and getting another high ESR wouldn't be useful. Doing a biopsy (specific) and seeing the features of TA will help you.

Anyone know about the question with the 70 year old who dies in a motor collision. He had been undergoing eval for occult blood in the stool. Transection of the transverse colon at autopsy shows one polyp (picture shown).

A) hyperplastic (wrong)
B) inflammatory psuedopolyp
C) juvenile
D) peutz Jegher
E) tubular adenoma

I guess it was tubular adenoma but why / what where they getting at? I thought you couldn't tell if it was hyperplastic vs adenoma grossly which is why you have to biopsy. Both can bleed... and hyperplastic is the most common polyp which is why I chose A.
Click to expand...


I also said hyperplastic and got it wrong but on a second look...70 yrs old is a good age to suspect neoplastic than non-neoplastic polyp (hyper plastic) and most importantly---it is pedunculated. which is a character of tubular adenoma. When I took it for the second time, I got it right (the same story for the TA. It is additional testing to confirm TA, I suppose they mean biopsy).
 
Last edited:
Upvote 0 Downvote
other than the fact that it looked like neoplastic polyp the tipoff was 70 years old, they want you to always rule out Colon Ca on every grandpa with a polyp.


An 80 year old woman is being evaluated for suspected temporal arteritis. Her ESR is 100mm/hr. Treatment of TA involves the use of glucocorticoids, which could have serious adverse effects. The pretest probability for TA is 50% in this patient. In evaluation of TA, ESR has sensitivity of 99%, and a specificity of 60%. Based on the results of the ESR testing in this patient, which of the following is the most appropriate step in management?

A. Additional testing to confirm dx of TA
B. Corticosteroid therapy, since the diagnosis of TA has been established with 99% certainty
C. Elimination of TA from further diagnostic consideration
D. Repeat ESR; if again positive, corticosteroid therapy
E. Repeat ESR; if normal, additional testing to confirm diagnosis of TA


I answered this one correctly and yes its A, the thing about this question is not the fact that is giant cell because ud start corticosteroid right away even without a biopsy because of the risk of blindness , but they arent focusing on that fact on this q, the give away on this one was that they mentioned the sens and spec, so its not a pathology question its actually a epidemiology dealing with pretest sens and spec stuff. sucks they picked a disease you are suppose to think and act aggressively.
 
  • Like
Reactions: 2 users
Upvote 0 Downvote
Yeah you guys are right about the gross. The age pushes the adenoma dx but hyperplastic is still more common even in elderly. I learned somewhere that you always biopsy polyps because you can't tell adenomatous vs hyperplastic grossly ... but I guess you can lol.
 
Upvote 0 Downvote
Ahhh I went down 11 points on NBME 17 from 16. I went from high 230s, to high 220s. I blanked on so many potentially easy things. Anyways here are most of them. Any help would be appreciated as I take the exam in less than a week
Guy lifting weights suddenly experiences painful swelling right inguinal area. Picture of resected part of small intestine. Dx?
  1. adhesions
  2. emboli
  3. intussusception (this i think)
  4. strangulation
  5. volvulus

55 y/o man with sepsis gets confused and anxious. Treated with vanco/ceftriaxone. Temp 104, BP 84/50. Warm flushed skin. Give what solution?
  1. dextrose in water only w/ saline
  2. dextrose in water only
  3. 0.45% saline
  4. 0.9% saline (pretty sure answer is just regular saline)
  5. 3% saline (not this)
Woman on triiodothyroxine for her hypothyroidism develops tremors and fatigue. She doubles her dose because of the fatigue. What do we expect on thyroid function test?
I said “decrease TSH, Increase free thyroxine, increase free T3”. I assume I was wrong about the free thyroxine? Does free thyroxine decrease because of something to do with thyroid binding globulin?

Man w/ generalized tonic clonic seizures. He has pins and needles in mouth, hands, feet. Involuntary contractions of muscles. Hyperflexia. Abnormality of what serum ion?
  1. bicarb
  2. calcium
  3. chloride (i picked)
  4. potassium
  5. sodium
I am drawing a complete blank on this and can't find it in first aid. I know I did this in UW.

woman w/ metastatic breast cancer has gradual onset decreased muscle contractions in left hand and left leg. Strength, DTR, sensation, proprioception normal. Where is metastatic tumor found on the left side?
  1. cerebellum
  2. cerebrum
  3. cervical spinal cord (I think its this. I missed the "left side" at the end of the question)
  4. lumbar spinal cord
  5. thoracic spinal cord
Underweight baby born w/ petechia rash, microcephaly, and hepatosplenomegaly. Serology of mom shows CMG IgG (+) and CMV IgM (-). Infant serology CMV IgG (+)/IgM (+). Explanation?
  1. active transfer maternal Ab
  2. congenital CMV infection (I think its this but why on earth is infant IgM (+) for CMV. IgM cant cross placenta)
  3. False negative maternal serology
  4. False positive infant serology (I picked this thinking the IgM + was a mistake. How can a neonate produce IgM on its own?!)
  5. Passive transfer IgM and IgG to infant
Craniopharyngioma derived from? Is the answer “diverticulum of root of embryonic oral cavity?” Another easy question ahh

Woman who’s 18 weeks pregnant gets hyperthroidism. What lab value confirms hyperthyroidism?
  1. free T4
  2. Radioactive iodiine uptake
  3. serum total T3
^I read this wrong and thought it was autoimmune so picked antibody answer

Broken mandible. What additional structure injured?
  1. inferior alveolar nerve
  2. levator labii superioris
  3. maxillary artery
  4. parotid gland (picked this thinking jaw went backwards and damaged it)
  5. tongue (im guessing tongue?)
14 y/0 boy brought in by mom for bilateral headaches aching in his temples. Hes not been himself lately. He is clumsy, has broad based ataxic gait. Slow to answering questions. Whats he abusing?
  1. cocaine
  2. ethanol (my choice. I realize now theres no way a 14 y/o would get B1 deficiency)
  3. inhaled glue (is this the answer?)
  4. methamphetamine
  5. PCP
previously healthy 35 y/o has one year history of depression, impulsiveness, and difficult. Grimaces intermittently and has rigid jerking purposeless movements. What historical factor relevant to diagnosis?
  1. dietary insufficiency
  2. exposure environmental toxins (thought it was lead poisoning. Nope)
  3. family hx
  4. pet w/ unexplained illness
  5. tick bite
  6. travel
55 y/o woman 6 week history of low energy, irritability, and crying spells. She has difficulty sleeping. Taking lorazepam for GAD for 15 years. Had postmenopausal sx for 1 year treated with estrogen therapy. Constricted affect. She feels testy and speech is slowed. Cause?
  1. estrogen toxicity
  2. GAD
  3. lorazepam toxicity
  4. MDD
  5. menopause
3 y/o with sickle cell has fever and increased foot pain for 3 weeks. Hematocrit stable. Increased leukocytes with prominence of neutrophils.

Osteomyeltiis or avascular necrosis? Another easy question ahh. I think its osteomyelitis.

20 weeks gestational pregnancy. Increased fundal height. Increases amniotic fluid. Cause?
  1. cleft lip
  2. encephalocele (i picked. wrong)
  3. renal agenesis
  4. tracheoesophageal atresia (i think this is the answer)
constipated old man. Distended abdomen. What nerve not working?
  1. interior rectal
  2. pelvic splanchnic
  3. perineal (my choice. wrong)
  4. sacral sympathetic
 
Last edited:
Upvote 0 Downvote
NoLollipops4U said:
Ahhh I went down 11 points on NBME 17 from 16. I went from high 230s, to high 220s. I blanked on so many potentially easy things. Anyways here are most of them. Any help would be appreciated as I take the exam in less than a week
Guy lifting weights suddenly experiences painful swelling right inguinal area. Picture of resected part of small intestine. Dx?
  1. adhesions
  2. emboli
  3. intussusception (this i think)
  4. strangulation <--- small intestine herniated and painful due to ischemia
  5. volvulus

55 y/o man with sepsis gets confused and anxious. Treated with vanco/ceftriaxone. Temp 104, BP 84/50. Warm flushed skin. Give what solution?
  1. dextrose in water only w/ saline
  2. dextrose in water only
  3. 0.45% saline
  4. 0.9% saline <--- boost the BP asap, so 0.9% normal saline; 3% too hypertonic, don't need the sugar
  5. 3% saline (not this)
Woman on triiodothyroxine for her hypothyroidism develops tremors and fatigue. She doubles her dose because of the fatigue. What do we expect on thyroid function test?
I said “decrease TSH, Increase free thyroxine, increase free T3”. I assume I was wrong about the free thyroxine? Does free thyroxine decrease because of something to do with thyroid binding globulin? what are the other answer choices? I think the Free T4 would go down, not up...

Man w/ generalized tonic clonic seizures. He has pins and needles in mouth, hands, feet. Involuntary contractions of muscles. Hyperflexia. Abnormality of what serum ion?
  1. bicarb
  2. calcium <-- too much Ca -> contractions of muscles
  3. chloride (i picked)
  4. potassium
  5. sodium
I am drawing a complete blank on this and can't find it in first aid. I know I did this in UW.

woman w/ metastatic breast cancer has gradual onset decreased muscle contractions in left hand and left leg. Strength, DTR, sensation, proprioception normal. Where is metastatic tumor found on the left side?
  1. cerebellum
  2. cerebrum <-- i think breast loves to go to brain, in brain mets lung > breast > GU > melanoma > GI, it's hand and leg vs just hand (cervical)
  3. cervical spinal cord (I think its this. I missed the "left side" at the end of the question)
  4. lumbar spinal cord
  5. thoracic spinal cord
Underweight baby born w/ petechia rash, microcephaly, and hepatosplenomegaly. Serology of mom shows CMG IgG (+) and CMV IgM (-). Infant serology CMV IgG (+)/IgM (+). Explanation?
  1. active transfer maternal Ab
  2. congenital CMV infection (I think its this but why on earth is infant IgM (+) for CMV. IgM cant cross placenta) <-- infant made IgM
  3. False negative maternal serology
  4. False positive infant serology (I picked this thinking the IgM + was a mistake. How can a neonate produce IgM on its own?!)
  5. Passive transfer IgM and IgG to infant
Craniopharyngioma derived from? Is the answer “diverticulum of root of embryonic oral cavity?” Another easy question ahh yes, rathke's pouch, ant pit

Woman who’s 18 weeks pregnant gets hyperthroidism. What lab value confirms hyperthyroidism?
  1. free T4 <-- usually this i believe, if not, then TSH?
  2. Radioactive iodiine uptake
  3. serum total T3
^I read this wrong and thought it was autoimmune so picked antibody answer

Broken mandible. What additional structure injured?
  1. inferior alveolar nerve <-- this this this, remember where dentists inject lidocaine for working on molar cavities
  2. levator labii superioris
  3. maxillary artery
  4. parotid gland (picked this thinking jaw went backwards and damaged it)
  5. tongue (im guessing tongue?)
14 y/0 boy brought in by mom for bilateral headaches aching in his temples. Hes not been himself lately. He is clumsy, has broad based ataxic gait. Slow to answering questions. Whats he abusing?
  1. cocaine
  2. ethanol (my choice. I realize now theres no way a 14 y/o would get B1 deficiency)
  3. inhaled glue (is this the answer?) <-- i think epidemiology on this.. PCP is more violent, cocaine would give you an eye sign, and meth they would say some sort of ADHD
  4. methamphetamine
  5. PCP
previously healthy 35 y/o has one year history of depression, impulsiveness, and difficult. Grimaces intermittently and has rigid jerking purposeless movements. What historical factor relevant to diagnosis?
  1. dietary insufficiency
  2. exposure environmental toxins (thought it was lead poisoning. Nope)
  3. family hx <-- i think this? some sort of inherited D receptor
  4. pet w/ unexplained illness
  5. tick bite
  6. travel
55 y/o woman 6 week history of low energy, irritability, and crying spells. She has difficulty sleeping. Taking lorazepam for GAD for 15 years. Had postmenopausal sx for 1 year treated with estrogen therapy. Constricted affect. She feels testy and speech is slowed. Cause?
  1. estrogen toxicity
  2. GAD
  3. lorazepam toxicity
  4. MDD <-- 6 week hx, SIGECAPS, don't think estrogen or menopause affects "affect", second choice is lorazepam
  5. menopause
3 y/o with sickle cell has fever and increased foot pain for 3 weeks. Hematocrit stable. Increased leukocytes with prominence of neutrophils.

Osteomyeltiis or avascular necrosis? Another easy question ahh. I think its osteomyelitis. osteomyelitis b/c of PMNs; otherwise avascular necrosis due to bone crises

20 weeks gestational pregnancy. Increased fundal height. Increases amniotic fluid. Cause?
  1. cleft lip
  2. encephalocele (i picked. wrong)
  3. renal agenesis -> leads to oligohydramnios
  4. tracheoesophageal atresia (i think this is the answer) <-- infant not swalloing amniotic fluid -> polyhydramnios
constipated old man. Distended abdomen. What nerve not working?
  1. interior rectal -> i think this is only for cutaneous sensation to external anal sphincter
  2. pelvic splanchnic <-- feeds external sphincter, need that to relax to poop!
  3. perineal (my choice. wrong)
  4. sacral sympathetic
Click to expand...
 
Upvote 0 Downvote
Edit: didn't realize someone beat me to it; I'll leave this here anyways since there might be some things not covered
Guy lifting weights suddenly experiences painful swelling right inguinal area. Picture of resected part of small intestine. Dx?
  1. adhesions
  2. emboli
  3. intussusception (this i think)
  4. strangulation
  5. volvulus
4. Strangulation: He has a hernia

55 y/o man with sepsis gets confused and anxious. Treated with vanco/ceftriaxone. Temp 104, BP 84/50. Warm flushed skin. Give what solution?
  1. dextrose in water only w/ saline
  2. dextrose in water only
  3. 0.45% saline
  4. 0.9% saline
  5. 3% saline (not this)
I think this one is 4. 0.9% Saline - you want to give normal saline, which is 0.9%

Woman on triiodothyroxine for her hypothyroidism develops tremors and fatigue. She doubles her dose because of the fatigue. What do we expect on thyroid function test?
I said “decrease TSH, Increase free thyroxine, increase free T3”. I assume I was wrong about the free thyroxine? Does free thyroxine decrease because of something to do with thyroid binding globulin?

Man w/ generalized tonic clonic seizures. He has pins and needles in mouth, hands, feet. Involuntary contractions of muscles. Hyperflexia. Abnormality of what serum ion?
  1. bicarb
  2. calcium
  3. chloride (i picked)
  4. potassium
  5. sodium
I am drawing a complete blank on this and can't find it in first aid. I know I did this in UW.

2. Calcium - These are symptoms of hypocalcemia (FA2015 pg 319)

woman w/ metastatic breast cancer has gradual onset decreased muscle contractions in left hand and left leg. Strength, DTR, sensation, proprioception normal. Where is metastatic tumor found on the left side?
  1. cerebellum
  2. cerebrum
  3. cervical spinal cord (I think its this. I missed the "left side" at the end of the question)
  4. lumbar spinal cord
  5. thoracic spinal cord
I think 2. Cerebrum - probably metastases from her breast cancer. An isolated loss of motor function in both upper and lower extremities makes me pick cerebrum over spinal cord.

Underweight baby born w/ petechia rash, microcephaly, and hepatosplenomegaly. Serology of mom shows CMG IgG (+) and CMV IgM (-). Infant serology CMV IgG (+)/IgM (+). Explanation?
  1. active transfer maternal Ab
  2. congenital CMV infection (I think its this but why on earth is infant IgM (+) for CMV. IgM cant cross placenta)
  3. False negative maternal serology
  4. False positive infant serology (I picked this thinking the IgM + was a mistake. How can a neonate produce IgM on its own?!)
  5. Passive transfer IgM and IgG to infant
2. My thought was that there was an intrauterine CMV infection in the neonate and not the mom. The fetus will produce both IgG and IgM, and pass the IgG to mom (reverse of what we normally think of).

Craniopharyngioma derived from? Is the answer “diverticulum of root of embryonic oral cavity?” Another easy question ahh

Yes; craniopharyngioma is from derivatives of Rathke's pouch (FA2015 493).

Woman who’s 18 weeks pregnant gets hyperthroidism. What lab value confirms hyperthyroidism?
  1. free T4
  2. Radioactive iodiine uptake
  3. serum total T3
^I read this wrong and thought it was autoimmune so picked antibody answer
1. Free T4 - I remember reading somewhere that T4 is a more reliable marker over T3; I think this question also is trying to get at the fact that total T3 and T4 are elevated in pregnancy, so free T4 is what you need to look at to confirm hyperthyroidism (my guess)

Broken mandible. What additional structure injured?
  1. inferior alveolar nerve
  2. levator labii superioris
  3. maxillary artery
  4. parotid gland (picked this thinking jaw went backwards and damaged it)
  5. tongue (im guessing tongue?)
1. The inferior alveolar nerve runs through the mandible

14 y/0 boy brought in by mom for bilateral headaches aching in his temples. Hes not been himself lately. He is clumsy, has broad based ataxic gait. Slow to answering questions. Whats he abusing?
  1. cocaine
  2. ethanol (my choice. I realize now theres no way a 14 y/o would get B1 deficiency)
  3. inhaled glue (is this the answer?)
  4. methamphetamine
  5. PCP
3. Inhaled glue, don't have a good explanation but it was NBME's correct answer

previously healthy 35 y/o has one year history of depression, impulsiveness, and difficult. Grimaces intermittently and has rigid jerking purposeless movements. What historical factor relevant to diagnosis?
  1. dietary insufficiency
  2. exposure environmental toxins (thought it was lead poisoning. Nope)
  3. family hx
  4. pet w/ unexplained illness
  5. tick bite
  6. travel
3. These symptoms make me think Huntington Disease (rigid jerking, mood disorders, early onset); Family history would help the most

55 y/o woman 6 week history of low energy, irritability, and crying spells. She has difficulty sleeping. Taking lorazepam for GAD for 15 years. Had postmenopausal sx for 1 year treated with estrogen therapy. Constricted affect. She feels testy and speech is slowed. Cause?
  1. estrogen toxicity
  2. GAD
  3. lorazepam toxicity
  4. MDD
  5. menopause
4. MDD - meets many of the diagnostic criteria (SIG-E-CAPS, not exactly >5/9 criteria, but this is the best choice of the answers)

3 y/o with sickle cell has fever and increased foot pain for 3 weeks. Hematocrit stable. Increased leukocytes with prominence of neutrophils.

Osteomyeltiis or avascular necrosis? Another easy question ahh. I think its osteomyelitis.

Yes Osteomyelitis - fever hints at it, and remember sickle cell patients have an increased risk for salmonella osteomyelitis

20 weeks gestational pregnancy. Increased fundal height. Increases amniotic fluid. Cause?
  1. cleft lip
  2. encephalocele (i picked. wrong)
  3. renal agenesis
  4. tracheoesophageal atresia (i think this is the answer)
Yep 4. Increases in amniotic fluid can be caused if the neonate isn't swallowing, either due to obstruction (tracheoesophageal atresia) or damage to swallowing center (anencephaly) FA2015 583

constipated old man. Distended abdomen. What nerve not working?
  1. interior rectal
  2. pelvic splanchnic
  3. perineal (my choice. wrong)
  4. sacral sympathetic
2. Pelvic splanchnics (S2,3,4) keeps the **** above the floor[/QUOTE]
 
  • Like
Reactions: 1 user
Upvote 0 Downvote
So not really sure what to think about this one:

A female newborn delivered at 36 weeks' gestation is in respiratory distress. Apgar scores are 3 and 5 at 1 and 5 minutes, respectively. Physical exam shows cyanosis. Endotracheal and nasogastric tubes are placed. The x-ray shown depicts the NG tube in the left hemithorax, displacement of the mediastinum to the right, and absence of bowel gas in the abdomen. This condition most likely results from which of the following embryologic events?

A. Failure of epimere to migrate
B. Failure of hypomere to migrate
C. Hypoplasia of lungs (Wrong)
D. Incomplete formation of pleuroperitoneal membrane
E. Malrotation of bowel
 
Upvote 0 Downvote
Radonculus08 said:
So not really sure what to think about this one:

A female newborn delivered at 36 weeks' gestation is in respiratory distress. Apgar scores are 3 and 5 at 1 and 5 minutes, respectively. Physical exam shows cyanosis. Endotracheal and nasogastric tubes are placed. The x-ray shown depicts the NG tube in the left hemithorax, displacement of the mediastinum to the right, and absence of bowel gas in the abdomen. This condition most likely results from which of the following embryologic events?

A. Failure of epimere to migrate
B. Failure of hypomere to migrate
C. Hypoplasia of lungs (Wrong)
D. Incomplete formation of pleuroperitoneal membrane
E. Malrotation of bowel
Click to expand...

It's D. Hypoplasia of the lungs is found in ARPKD because you aren't making enough fluid in the placenta and you need to "breathe" this fluid in order for your lungs to be the right size. This is a hernia through the diaphragm (incomplete formation of pleuroperitoneal membrane) causing an absence of bowel sounds in the abdomen and a hemithorax.

Also, I feel like I've seen this question before not on the the NBME)... I think it's from Rx?
 
  • Like
Reactions: 1 users
Upvote 0 Downvote
Thanks for the responses above!!!! Regarding a few of your comments

woman w/ metastatic breast cancer has gradual onset decreased muscle contractions in left hand and left leg. Strength, DTR, sensation, proprioception normal. Where is metastatic tumor found on the left side?
  1. cerebellum
  2. cerebrum (i picked this it was wrong. If the tumor is on the left side, sx would be on the right arm/leg)
  3. cervical spinal cord (^which is why im guessing cervical so it includes arms and legs)
  4. lumbar spinal cord
  5. thoracic spinal cord

I thought babies cant make antibodies for the first 6 months after birth and have to rely on Ab that crossed the placenta before birth?? Is the 6 months referring to the gestation?! (regarding CMV antibody question). Can someone please clarify?

Woman on triiodothyroxine for her hypothyroidism develops tremors and fatigue. She doubles her dose because of the fatigue. What do we expect on thyroid function test? Answer choices were basically a combination of all the possible lab values for TSH, Free Thyroxine, and Free Triiodothyroxine.
TSH down from negative feedback.....Im guessing that by increasing free T3 you will saturate TBG sites quickly as well as have left over free T3. So free T3 increases? Im not sure about Free T4. Answers choices are up or down. I picked i goes up. This was wrong. So why would free T4 decrease?
 
Last edited:
Upvote 0 Downvote
smarts1 said:
It's D. Hypoplasia of the lungs is found in ARPKD because you aren't making enough fluid in the placenta and you need to "breathe" this fluid in order for your lungs to be the right size. This is a hernia through the diaphragm (incomplete formation of pleuroperitoneal membrane) causing an absence of bowel sounds in the abdomen and a hemithorax.

Also, I feel like I've seen this question before not on the the NBME)... I think it's from Rx?
Click to expand...

I saw it in UW I believe. Its definitely D, I got that correct
 
Upvote 0 Downvote
Woman who’s 18 weeks pregnant gets hyperthroidism. What lab value confirms hyperthyroidism?
  1. TSH- Reduced
  2. free T4 -Decreased ( Because of reduced TSH from neg feedback by T3) Remember T3 can not be converted to T4.
  3. Free T3- Increased (Since thats what she's eating)
Got this one right.

And Your Previous question you are correct with thinking.. Tumor in Cervical Spinal Cord.
 
Last edited:
Upvote 0 Downvote
Anyone Know this One:

A 56 year old Woman comes to the physician for a follow up examination after recovering from Pneumococcal Pneumonia, X-ray shows no abnormalities. What allowed for full resolution:

1. Formation of granulation tissue
2. Increased Angiogenesis
3. Maintenance Of basement membrane integrity
4. Metaplasia of mesenchymal cells to pneumocytes
5. Prolif of fibroblasts

??
 
Upvote 0 Downvote
dr.AG1989 said:
Anyone Know this One:

A 56 year old Woman comes to the physician for a follow up examination after recovering from Pneumococcal Pneumonia, X-ray shows no abnormalities. What allowed for full resolution:

1. Formation of granulation tissue
2. Increased Angiogenesis
3. Maintenance Of basement membrane integrity
4. Metaplasia of mesenchymal cells to pneumocytes
5. Prolif of fibroblasts

??
Click to expand...
should be metaplasia of mesenchymal cells? type 2 pneumocytes proliferate in damage... shouldn't be fibroblasts and shouldn't be BM integrity (think this references invasion of cells)... second choice is granulation tissue but i feel that this leads to fibroblasts again.
 
  • Like
Reactions: 1 users
Upvote 0 Downvote
You must log in or register to reply here.
Next unread thread

Similar threads

D
NBME forms or UWORLD ~2 weeks out from Step1
Replies
3
Views
2K
shemer77
S
S
  • Question
Old NBME Forms or New NBME Forms?
Replies
0
Views
3K
Shammyguy3
S
M
  • Question
New NBME exams 25-30
Replies
36
Views
70K
JMS54
J
M
  • Locked
  • Question
[Spoiler] NBME 20 question
Replies
0
Views
820
maieutic
M
C
  • Question
If our school has been administering NBME-style exams, how close is it to the NBME practice tests?
Replies
1
Views
2K
jspar1
J
Top