NBME 17 discussion

[fatwalletuab]

Can you guys correct me on this
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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)
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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)
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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
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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.
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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!
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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
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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?!
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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
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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??
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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.
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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

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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

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[Bbot]

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

??

image shows no abnormalities so everything went back to normal
1. granulation tissue would show on xray
2.angiogenesis would also show (ud see increased lung vascularity)
3. maintenance of basement membrane integrity ( correct) meaning everything staid normal nothing broke no edema no scars)
4.Metaplasia of mesenchymal cells to pnemuocytes (not sure but pneumocytes once destroyed dont regenerate from another cell so ud endup with fibrosis of the lung, they divide so as long as you dont knock them all out ud be ok but)
5.fibroblasts fibrosis, Xray.

that was my way of thinking on this one was surprised actually it wasnt wrong normaly i overthink and get stuff wrong

 

[Radonculus08]

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.

Just a heads up, I picked Metaplasia of mesenchymal cells to pneumocytes as well and it was incorrect

 

[IceCastle]

Did anyone think this was easier than previous NBMEs? I did much better on this than previous ones.

 

[NoLollipops4U]

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.

Thanks for the response. I found FA was too basic about thyroid physiology, so where does TBG play into this? I read about it in Rapid Review last night and Im still a little confused

Unless its a pregnant patient, nephrotic syndromes, or steroids......assume TBG is constant and each TBG is only 1/3rd occupied by T3 and T4? So how would TBG look in the above patient receiving exogenous T3? Is it safe to assume TBG would be much more saturated with T3?

 

[SolarLuminosity]

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.

It is not Cervical Spinal Cord. I answered this and was wrong. Any help from anyone who got the question about tumor metastases right? I am thinking cerebellum.

 

[NoLollipops4U]

Did anyone think this was easier than previous NBMEs? I did much better on this than previous ones.

No. I dropped about 10 points from NBME 16. I guess overall the questions were similar, I just made some really basic mistakes. I usually get all ethics questions correct and I got 2-3 wrong on NBME 17. I have no idea what the USMLE expects anymore. I always try to pick neutral sort of answers that allow patients to speak their mind or specific laws.......yet somehow "An old woman wants her friend to hang out at the hospice, and its cool she can stay despite it breaking the rules". I get that would be answer in real life, but I have found the answers to ethics questions on NBMEs so far to not be what you would do in real life but rather the politically correct answer. I guess I was just a little shocked. Same goes for the cold "Yes, it is bad news." answer. Not even easing them in!

How many incorrect did you get and what was your score? I suspect the SD is narrow, like it was on NBME 16 and 15. I know every NBME is slightly different, but I got 3 more incorrects on NBME 17 and that was enough to drop my 10 points

 

[NoLollipops4U]

It is not Cervical Spinal Cord. I answered this and was wrong. Any help from anyone who got the question about tumor metastases right? I am thinking cerebellum.

Lesion on the left side of cerebellum would cause ipsilateral limb problems so that makes sense! I suppose if the metastatic site was the cervical spinal cord....what are the actual odds of it only disrupting specific tracks. It's pretty unlikely. Glad you pointed out that you got it wrong

 

[IceCastle]

No. I dropped about 10 points from NBME 16. I guess overall the questions were similar, I just made some really basic mistakes. I usually get all ethics questions correct and I got 2-3 wrong on NBME 17. I have no idea what the USMLE expects anymore. I always try to pick neutral sort of answers that allow patients to speak their mind or specific laws.......yet somehow "An old woman wants her friend to hang out at the hospice, and its cool she can stay despite it breaking the rules". I get that would be answer in real life, but I have found the answers to ethics questions on NBMEs so far to not be what you would do in real life but rather the politically correct answer. I guess I was just a little shocked. Same goes for the cold "Yes, it is bad news." answer. Not even easing them in!

How many incorrect did you get and what was your score? I suspect the SD is narrow, like it was on NBME 16 and 15

Yeah, I got really lucky on the ethics questions because I guessed on all of them and got them all correct. The hospice question was tricky, but I just put what I would do in real life. The "Yes, it is bad news" was more straightforward to me because I knew that you had to be direct in that situation, and all of the answer choices were kind of terrible.

 

[SolarLuminosity]

Does anyone know what the age in months of the girl who has pincer grasp, finger feeding, helped standing, and plays peekaboo? 3,9,15,21,27. I put 15 and was wrong. Thanks!

 

[NoLollipops4U]

Yeah, I got really lucky on the ethics questions because I guessed on all of them and got them all correct. The hospice question was tricky, but I just put what I would do in real life. The "Yes, it is bad news" was more straightforward to me because I knew that you had to be direct in that situation, and all of the answer choices were kind of terrible.

I just realized I also got an external hemorrhoid question incorrect. Where was the thrombi located? I said inferior rectal artery, which was wrong. I assume it was inferior rectal vein? This would cause fluid to back up behind the block and cause the hemorrhoid I guess. Can hemorrhoids be cause by ischemia?

 

[NoLollipops4U]

Does anyone know what the age in months of the girl who has pincer grasp, finger feeding, helped standing, and plays peekaboo? 3,9,15,21,27. I put 15 and was wrong. Thanks!

I don't remember the choices, but I think it was 9 months. I put the answer choice right under 1 year but not as low as 6 months(which I think was another choice)

The milestones are literally the only section in FA I refuse to learn and memorize haha but got lucky with this question. Im going off walking and babinski if it comes up on the real deal

 

[syoung]

Lesion on the left side of cerebellum would cause ipsilateral limb problems so that makes sense! I suppose if the metastatic site was the cervical spinal cord....what are the actual odds of it only disrupting specific tracks. It's pretty unlikely. Glad you pointed out that you got it wrong

Ya this makes sense!
a lesion in just the cervical spinal cord would be unlikely hit the limb as well as the leg alone...

 

[IceCastle]

I just realized I also got an external hemorrhoid question incorrect. Where was the thrombi located? I said inferior rectal artery, which was wrong. I assume it was inferior rectal vein? This would cause fluid to back up behind the block and cause the hemorrhoid I guess. Can hemorrhoids be cause by ischemia?

To my knowledge, hemorrhoids are caused by venous blockage (remember that hemorrhoids form in the setting of cirrhosis from the renal varices). Inferior rectal vein was the best answer.

 

[syoung]

Does anyone know what the age in months of the girl who has pincer grasp, finger feeding, helped standing, and plays peekaboo? 3,9,15,21,27. I put 15 and was wrong. Thanks!

3 months can't stand up
12 months should be able to stand freely, so 9 months you can hold the table and stand
6 months sweeping w/ arms and 9 months some better fine motor skills (pincer grasp)

 

[NoLollipops4U]

To my knowledge, hemorrhoids are caused by venous blockage (remember that hemorrhoids form in the setting of cirrhosis from the renal varices). Inferior rectal vein was the best answer.

Makes sense thanks!

Is anyone else willing to share the # of incorrect with their score? This is an anonymous forum

 

[Bbot]

Thanks for the response. I found FA was too basic about thyroid physiology, so where does TBG play into this? I read about it in Rapid Review last night and Im still a little confused

Unless its a pregnant patient, nephrotic syndromes, or steroids......assume TBG is constant and each TBG is only 1/3rd occupied by T3 and T4? So how would TBG look in the above patient receiving exogenous T3? Is it safe to assume TBG would be much more saturated with T3?

TBG its not constant in pregnancy remember that estrogen upregulates binding globulins so preg woman would have high total t3/74 but regular free t3/t4 so the correct answer for actually hyperthyroidism must be free not total.

No. I dropped about 10 points from NBME 16. I guess overall the questions were similar, I just made some really basic mistakes. I usually get all ethics questions correct and I got 2-3 wrong on NBME 17. I have no idea what the USMLE expects anymore. I always try to pick neutral sort of answers that allow patients to speak their mind or specific laws.......yet somehow "An old woman wants her friend to hang out at the hospice, and its cool she can stay despite it breaking the rules". I get that would be answer in real life, but I have found the answers to ethics questions on NBMEs so far to not be what you would do in real life but rather the politically correct answer. I guess I was just a little shocked. Same goes for the cold "Yes, it is bad news." answer. Not even easing them in!

How many incorrect did you get and what was your score? I suspect the SD is narrow, like it was on NBME 16 and 15. I know every NBME is slightly different, but I got 3 more incorrects on NBME 17 and that was enough to drop my 10 points

about the hospice laidy that q got me a little angry because how how they said "friends" they ment they are lesbians, and been together since for ever, so they basically a married couple so you arent legally family but heck... they are, so no one will complain and dont tell the patient to lie lol thats always not good ( actually learned this the rly ****ty way i once tried telling a patient to say a little white lie obg rotation and backfired me she said its bad to lie and bla blah :S lol)

anyhow i was also having problem in behavioral qs untill i got the hang of do the following
1-Never lie ( easy lol even if it sounds brutal or that ull get a lawsuit)
2-dont be nice ( doesnt mean be rude or inpolite, but most qs i used to get wrong i was trying to be nice to the patient and thats not always what they want on this questions, so if they have a mole in the face or acnee instead of trying for the nice approach like it doesnt look so bad or d/w it will get better soon...(what a random person would say) they want you to just say shes it can be hard to have pimples in ur face... even if the answer doesnt actually help its just some psychiatry mombojombo
3- dont give false hope or be optimistic dont say a ugly mole might be nothing d/w cuz it can be cancer and ur lying and all that ;S

you guys know most of those things but the the hardest part is figuring out the (being nice distractor choices).


i got a 234 with 30 questions wrong
not sucha good score ehehe but w/e i missed tons easy ones kinda angry about that

 

[NoLollipops4U]

TBG its not constant in pregnancy remember that estrogen upregulates binding globulins so preg woman would have high total t3/74 but regular free t3/t4 so the correct answer for actually hyperthyroidism must be free not total.



about the hospice laidy that q got me a little angry because how how they said "friends" they ment they are lesbians, and been together since for ever, so they basically a married couple so you arent legally family but heck... they are, so no one will complain and dont tell the patient to lie lol thats always not good ( actually learned this the rly ****ty way i once tried telling a patient to say a little white lie obg rotation and backfired me she said its bad to lie and bla blah :S lol)

anyhow i was also having problem in behavioral qs untill i got the hang of do the following
1-Never lie ( easy lol even if it sounds brutal or that ull get a lawsuit)
2-dont be nice ( doesnt mean be rude or inpolite, but most qs i used to get wrong was trying to be nice to the patient, if they have a mole in the face or acnee instead of trying for the nice approach like it doesnt look so bad or d/w it will get better soon...(what a random person would say) they want you to just say shes it can be hard to have pimples in ur face... even if the answer doesnt actually help its just some psychiatry mombojombo
3- dont give false hope or be optimistic dont say a ugly mole might be nothing d/w cuz it can be cancer and ur lying and all that ;S

you guys know most of those things but the the hardest part is figuring out the (being nice distractor choices).


i got a 234 with 30 questions wrong
not sucha good score ehehe but w/e i missed tons easy ones kinda angry about that

I got 228 with 36 wrong. Thats actually a wider SD than I expected. I cant remember if it was NBME 15 or 16, but I was reading peoples # wrongs Vs score and the difference of 2 questions was about 5 points when in the same area we are. I think in the right mind set, I could have had an additional 6-10 questions being semi-realistic going over answers. I read way too many questions wrong or ignored the whole question. I hope ill be more careful Tuesday when I take it. There are many things that I simply just dont know at this point and I accept that. However, there was quite a few gimme questions (excluding ethics) that can be missed if not in the right mindset. I think I proved that to myself with NBME 17 (228) vs high 230s on NBME 16 a few days ago. Good luck

 

[Charmer]

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.

So which one did you pick? Here is an explanation I read it's a bit tricky but the general vibe was total T4 gets elevated because of b-hCG acting on thyroid gland b.c of it similarity with TSH. However, free T4 and T3 (the active form of T4 and T3) remains normal and TSH gets reduced....it was a challenging question. I finally picked Ft4 and got it right!

 

[Bbot]

I got 228 with 36 wrong. Thats actually a wider SD than I expected. I cant remember if it was NBME 15 or 16, but I was reading peoples # wrongs Vs score and the difference of 2 questions was about 5 points when in the same area we are. I think in the right mind set, I could have had an additional 6-10 questions being semi-realistic going over answers. I read way too many questions wrong or ignored the whole question. I hope ill be more careful Tuesday when I take it. There are many things that I simply just dont know at this point and I accept that. However, there was quite a few gimme questions (excluding ethics) that can be missed if not in the right mindset. I think I proved that to myself with NBME 17 (228) vs high 230s on NBME 16 a few days ago. Good luck

ooh dude you're taking it on Tuesday!!? me too eheheh good luck


and the i chose T4, and i honestly remember the q saying free t4 and total t3 but lol almost 2 weeks since i took it and since i got it right cant see it. and yes first aid is way way too easy on tiroid gland lol its probably the most important endocrine organ lol where the endocrinologists go loco even tho all they do is treat diabetes ( no offence ehhee they are very smart but diabetes its just way way 2 common )

 

[Charmer]

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.

It is BM integrity ( I got it right)...it is in comparison to Tb, which causes disruption of the BM and leaves a scar (although not always) unlike pneumonia which resolves completely once treated well.

 

[Dr.G1989]

Thanks for the response. I found FA was too basic about thyroid physiology, so where does TBG play into this? I read about it in Rapid Review last night and Im still a little confused

Unless its a pregnant patient, nephrotic syndromes, or steroids......assume TBG is constant and each TBG is only 1/3rd occupied by T3 and T4? So how would TBG look in the above patient receiving exogenous T3? Is it safe to assume TBG would be much more saturated with T3?

Good Question! I think TBG might go down due to suppression of TSH?? I'm not sure, but definetly increased saturation. Anyone know about this one?? But then shes pregnant so maybe it would be elevated or normal...Need clarification on this. Thanks

Lesion on the left side of cerebellum would cause ipsilateral limb problems so that makes sense! I suppose if the metastatic site was the cervical spinal cord....what are the actual odds of it only disrupting specific tracks. It's pretty unlikely. Glad you pointed out that you got it wrong

Makes sense thanks!

Sorry I took it almost 3 weeks ago, I thought I answered Cervical Spinal Cord...I guess maybe I didn't.

Is anyone else willing to share the # of incorrect with their score? This is an anonymous forum

UWSA 1- 235 (Mid Jan)
NBME 16- 232 (520) with 37 Incorrect (Early Feb)
UWSA 2- 242 (a couple days after NBME 16)
NBME 15- 217 (450) with 47 Incorrect (15 Days after NBME 16. MAJOR let down)

Rescheduled and repayed for my exam after NBME 15 as extension period ended (3months + 3months extension)

NBME 11- 25 Incorrect (offline) (4 Weeks ago) I think that works out to 241-243 based on other peoples scores.

NBME 17- 234 (530) 29 Incorrect (2+ weeks ago) (So many stupid mistakes) Felt it was comparable to 16, maybe a little easier than 15, but had a bunch of weird ethics and a couple of physio questions. But that being said I felt there were many easy questions like more straight forward. Also I cheated on a few lol which I gelt bad for later. There were a bunch that were just straight up re-call. Like the occulomotor nerve in the cavernous sinus diagram, and the dermatome for appendicitis, a couple others but those were the 2 that I wasn't 100% on so looked up

NBME 13- 243 (570) with 26 Incorrect (Last week)


I feel like my scores are pretty horrible compared to most of the people on this forum...it almost feels like 250+ is almost average here!! I actually personally only know one person that got over 250 (265) but he studied hard every single day and for more than 2 years. What are you people eating??? lol I've been studying for more than 8 months now and my scores haven't budged in the last 2 months. Not really sure what I'm doing wrong.

I think I'm just going to go ahead and bite the bullet, just picked my date for monday, crossing my fingers and hoping for the best. I just want this hell to be over with.

So which one did you pick? Here is an explanation I read it's a bit tricky but the general vibe was total T4 gets elevated because of b-hCG acting on thyroid gland b.c of it similarity with TSH. However, free T4 and T3 (the active form of T4 and T3) remains normal and TSH gets reduced....it was a challenging question. I finally picked Ft4 and got it right!

Do You remember the exact question?? It wasn't in my incorrects.

 

[syoung]

monday's my day tooooo

 

[syoung]

the thyroid hormone question was:
late 20's woman w/ 5week hx of fatigue and 4day hx of heart palps and anxiety. primary hypothyroidism tx w/ T3. doubled dose in the past week b/c of fatigue. HR 112, Bp 126/70. PE shows fine tremor. DTRs are brisk. what thyroid fxn tests?
TSH _______ FT4 ________ FT3
up ________ up _________ up
up ________ up _________ down
up ________down _______ up
down ______ up _________ up
down ______ up _________ down
down ______ down _______ up

 

[Dr.G1989]

the thyroid hormone question was:
late 20's woman w/ 5week hx of fatigue and 4day hx of heart palps and anxiety. primary hypothyroidism tx w/ T3. doubled dose in the past week b/c of fatigue. HR 112, Bp 126/70. PE shows fine tremor. DTRs are brisk. what thyroid fxn tests?
TSH _______ FT4 ________ FT3
up ________ up _________ up
up ________ up _________ down
up ________down _______ up
down ______ up _________ up
down ______ up _________ down
down ______ down _______ up

TSH- Down
Free T4- Down
Free T3- Up

 

[Dr.G1989]

monday's my day tooooo

Good Luck!! Lets hope for a good paper for both of us!!

 

[Bbot]

isn't it tsh down, t3 down, t4 up? i dont have this as a wrong question and dont remember this question but for my understanding and if thats what i think then i guess i put that in the exam was t4 up, most medications for hypothyroidism are t4 actually i remember reading that the t3 half life its 2 low so they give t4.

Edit: talked to a friend of mine he took it this week, and the question is t3 up and t4 down because on the stem of the question says shes taking a t3 drug.

btw what are you guys doing with your last days i was reviewing the uwsa i did 2 days ago and now going again on my weak areas :s im going crazy i cant sleep lol :S.

 

[syoung]

isn't it tsh down, t3 down, t4 up? i dont have this as a wrong question and dont remember this question but for my understanding and if thats what i think then i guess i put that in the exam was t4 up, most medications for hypothyroidism are t4 actually i remember reading that the t3 half life its 2 low so they give t4.

Edit: talked to a friend of mine he took it this week, and the question is t3 up and t4 down because on the stem of the question says shes taking a t3 drug.

btw what are you guys doing with your last days i was reviewing the uwsa i did 2 days ago and now going again on my weak areas :s im going crazy i cant sleep lol :S.

rapid review ftw. procrastinating. plus re-skimming behavioral, biochem, and the high yield micro at the end of the micro chapter of FA. procrastinating. reviewing missed ?s from 2nd pass of incorrects on uworld. procrastinating. going for walks. exercising. getting ice cream. procrastinating. being sore from said exercising. gazing forlornly out of my study room. did i mention procrastinating?

 

[Dr.G1989]

isn't it tsh down, t3 down, t4 up? i dont have this as a wrong question and dont remember this question but for my understanding and if thats what i think then i guess i put that in the exam was t4 up, most medications for hypothyroidism are t4 actually i remember reading that the t3 half life its 2 low so they give t4.

Edit: talked to a friend of mine he took it this week, and the question is t3 up and t4 down because on the stem of the question says shes taking a t3 drug.

btw what are you guys doing with your last days i was reviewing the uwsa i did 2 days ago and now going again on my weak areas :s im going crazy i cant sleep lol :S.

rapid review ftw. procrastinating. plus re-skimming behavioral, biochem, and the high yield micro at the end of the micro chapter of FA. procrastinating. reviewing missed ?s from 2nd pass of incorrects on uworld. procrastinating. going for walks. exercising. getting ice cream. procrastinating. being sore from said exercising. gazing forlornly out of my study room. did i mention procrastinating?

HAHAHAHA! I've been like zero productive today. So I guess its all of us. My plan was to re read all of FA in the last week but i've barely gotten thru 30%. Procrastinate, Procrastinate, stare at the wall.....freak out, study, stare at the wall....Game of thrones! Btw the first 4 episodes were leaked on torrents just in case someone else is a fan!

 

[Bbot]

agh no1 posting anymore qs so ehehe fck it, i havent been staring at a wall lol but ive beens staring at the book and freaking out =/ im like reading a page and 30minutes go by and im still on the same paragraph :S its like it changed language, then i read a few lines and freak out like dapsone im like whats that i havent heard of it ever! and this other thing aspirin wtf >.< is it for aspiration pneumonia ? asp? !!! ( if this keeps on im just glad my permit has my name )

edit: the dapsone one is real i was like whats that!! and googled it and while googling i heard goljans voice saying you idiot!

 

[IceCastle]

9 wrong was a 266.

 

[NoLollipops4U]

Oh man I've been procrastinating too. I walked out of the library at 3 yesterday and havent studied since, except I blew the dust of rapid review last night and casually read a bit. It was actually pretty good, now that I know a lot more. When you start board studying, it seems overwhelming. RAPID REVIEW EXPLAINS THE THYROID STUFF REALLY WELL. There is also good pictures of derm stuff which i liked.

THese last 3 days are going to be brutal (taking monday off fully, and golfing tomorrow morning). High stress, low productivity. I will re-read some weak points though. Soooo many of my friends in M4 are telling me to take 1-2 days off before the exam or else you will crash and burn since its obviously a marathon sitting for 7 blocks. WE ARE ALMOST DONE!!!!!!!

 

[NoLollipops4U]

btw what are you guys doing with your last days i was reviewing the uwsa i did 2 days ago and now going again on my weak areas :s im going crazy i cant sleep lol :S.

You see friend, I cheated for the first time in my life. I was getting awful sleeps the last month and it was affecting my study. So I saw a doc and got prescribed sleep meds. Not any of the crazy addicting ones, just a lighter low dose one called zopiclone. Best sleeps of my life even with the stress.

 

[Bbot]

i was thinking about taking some meds but then decided not too dont want anything to mess with my thinking process during the exam unless it changed it entirely to mr icecastle's and i can hit that 260+ ;P i just want 230+ on the real exam lol and i will forever admire those guys hitting 250+ lol

 

[syoung]

You see friend, I cheated for the first time in my life. I was getting awful sleeps the last month and it was affecting my study. So I saw a doc and got prescribed sleep meds. Not any of the crazy addicting ones, just a lighter low dose one called zopiclone. Best sleeps of my life even with the stress.

what's the MoA of your drug and contraindications and side effects and .....

 

[Charmer]

Good Question! I think TBG might go down due to suppression of TSH?? I'm not sure, but definetly increased saturation. Anyone know about this one?? But then shes pregnant so maybe it would be elevated or normal...Need clarification on this. Thanks





UWSA 1- 235 (Mid Jan)
NBME 16- 232 (520) with 37 Incorrect (Early Feb)
UWSA 2- 242 (a couple days after NBME 16)
NBME 15- 217 (450) with 47 Incorrect (15 Days after NBME 16. MAJOR let down)

Rescheduled and repayed for my exam after NBME 15 as extension period ended (3months + 3months extension)

NBME 11- 25 Incorrect (offline) (4 Weeks ago) I think that works out to 241-243 based on other peoples scores.

NBME 17- 234 (530) 29 Incorrect (2+ weeks ago) (So many stupid mistakes) Felt it was comparable to 16, maybe a little easier than 15, but had a bunch of weird ethics and a couple of physio questions. But that being said I felt there were many easy questions like more straight forward. Also I cheated on a few lol which I gelt bad for later. There were a bunch that were just straight up re-call. Like the occulomotor nerve in the cavernous sinus diagram, and the dermatome for appendicitis, a couple others but those were the 2 that I wasn't 100% on so looked up

NBME 13- 243 (570) with 26 Incorrect (Last week)


I feel like my scores are pretty horrible compared to most of the people on this forum...it almost feels like 250+ is almost average here!! I actually personally only know one person that got over 250 (265) but he studied hard every single day and for more than 2 years. What are you people eating??? lol I've been studying for more than 8 months now and my scores haven't budged in the last 2 months. Not really sure what I'm doing wrong.

I think I'm just going to go ahead and bite the bullet, just picked my date for monday, crossing my fingers and hoping for the best. I just want this hell to be over with.



Do You remember the exact question?? It wasn't in my incorrects.

28 y.o.- lady, 18wks Gestation with palpitation. Serum total T4 is elevated. what do we do to confirm hyperthyroidism?

Choices were,
-FNA of thyroid (good for enlarged thyroid or nodule)
-Free T4
-Radio active iodine uptake check (contraindicated in Pregnancy)
-Serum Total T3 (can be falsely elevated bc of b-hCG stimulation of the gland)
-Thyroid antibodies- ( These are not wrong I suppose but not the best answer, considering that even if they are high, they finally lead to hyperthyroidism and may be lately to hypothyroidism...making it less favorable)

One one choice remains .

 

[NoLollipops4U]

i was thinking about taking some meds but then decided not too dont want anything to mess with my thinking process during the exam unless it changed it entirely to mr icecastle's and i can hit that 260+ ;P i just want 230+ on the real exam lol and i will forever admire those guys hitting 250+ lol

I just want a 230-240. I used to strive for 240+ but Ive studying for a long time and I am past my peak. Yeah i was skeptical about taking them at first but I started a few weeks ago so im used to them now. I also truly admire people who break 240 because I understand now how hard it is to break that

what's the MoA of your drug and contraindications and side effects and .....

MOA: nonbenzo hypnotic. Binds some sort of receptors with Z in the name lol
SE: best dam sleeps of my life
Contraindications: drinking lots of alcohol haha I was warned it could severely depress my breathing

 

[NoLollipops4U]

28 y.o.- lady, 18wks Gestation with palpitation. Serum total T4 is elevated. what do we do to confirm hyperthyroidism?

Choices were,
-FNA of thyroid (good for enlarged thyroid or nodule)
-Free T4
-Radio active iodine uptake check (contraindicated in Pregnancy)
-Serum Total T3 (can be falsely elevated bc of b-hCG stimulation of the gland)
-Thyroid antibodies- ( These are not wrong I suppose but not the best answer, considering that even if they are high, they finally lead to hyperthyroidism and may be lately to hypothyroidism...making it less favorable)

One one choice remains .

Free T4

I panicked and picked antibodies, i thought it was some kind of autoimmune pregnancy thing haha

 

[bortenson]

Assume I'm overthinking this one...

A 40 y/o f comes to physician; 1 yr history of crampy abdominal pain, diarrhea, rectal bleeding, passage of mucus. BMI 18. Diffuse abdominal tenderness, no rebound tenderness. A few diffuse ulcers on sigmoidoscopy. Most appropriate initial pharacoptherapy =?

A) Amoxicillin
B) Bismuth Subsalicylate
C) Loperamide
D) Octreotide
E) Sulfasalazine

Is the answer simply Sulfalazine for ulcerative colitis? My mind jumped to annorexia w/ laxative misuse.

Edit: 1 more, just to make sure I'm logick-ing this one right...

55 y/o M with chronic bronchitis, brought to ED after found unresponsive in bed. Bottles of Albuterol, ampicillin, codeine and theophylline on his bedside table. Temp 37.2C (99F), pulse 112/min, resp 6/min, bp 95/60. Acute treatment should include:

A) Flumazenil (no, benzos)
B) Fomepizole (no, toxic alcohols)
C) Hemodialysis (unlikely?)
D) Naloxone
E) Propanolol

My thought, is that Propanolol (or any b-blocker) could exacerbate underlying chronic bronchitis, especially since considering his bradypnea. Therefore, even though B-blockers are an antidote for theopylline, his respiratory depression is more pressing, and likely due to codeine overdose, which would best be treated by naloxone. Yes?

 

[blueshockey]

Assume I'm overthinking this one...

A 40 y/o f comes to physician; 1 yr history of crampy abdominal pain, diarrhea, rectal bleeding, passage of mucus. BMI 18. Diffuse abdominal tenderness, no rebound tenderness. A few diffuse ulcers on sigmoidoscopy. Most appropriate initial pharacoptherapy =?

A) Amoxicillin
B) Bismuth Subsalicylate
C) Loperamide
D) Octreotide
E) Sulfasalazine

Is the answer simply Sulfalazine for ulcerative colitis? My mind jumped to annorexia w/ laxative misuse.

I agree with E. Her presentation doesn't really fit the bill of an infectious diarrhea, so A is out. Her ulcers are on sigmoidoscopy (not gastric), so B is out. Loperamide is also called Imodium, which doesn't really address the underlying issue although it is used for diarrhea. Octreotide isn't really relevant either (acromegaly, varices, carcinoid), so I think the answer is probably E!

 

[Bbot]

Assume I'm overthinking this one...

A 40 y/o f comes to physician; 1 yr history of crampy abdominal pain, diarrhea, rectal bleeding, passage of mucus. BMI 18. Diffuse abdominal tenderness, no rebound tenderness. A few diffuse ulcers on sigmoidoscopy. Most appropriate initial pharacoptherapy =?

A) Amoxicillin
B) Bismuth Subsalicylate
C) Loperamide
D) Octreotide
E) Sulfasalazine

Is the answer simply Sulfalazine for ulcerative colitis? My mind jumped to annorexia w/ laxative misuse.

Edit: 1 more, just to make sure I'm logick-ing this one right...

55 y/o M with chronic bronchitis, brought to ED after found unresponsive in bed. Bottles of Albuterol, ampicillin, codeine and theophylline on his bedside table. Temp 37.2C (99F), pulse 112/min, resp 6/min, bp 95/60. Acute treatment should include:

A) Flumazenil (no, benzos)
B) Fomepizole (no, toxic alcohols)
C) Hemodialysis (unlikely?)
D) Naloxone
E) Propanolol

My thought, is that Propanolol (or any b-blocker) could exacerbate underlying chronic bronchitis, especially since considering his bradypnea. Therefore, even though B-blockers are an antidote for theopylline, his respiratory depression is more pressing, and likely due to codeine overdose, which would best be treated by naloxone. Yes?

First isE you guys got it. The second one ye... i also freaked a bit, but then i calmed myaelf and read it again and its actually very easy look at his vitals forget all those meds and ull see that hea bp aint that bad and he is actually responding to the drop bp with high HR ao he isnt bblocked but then you can notice hes only taking 6 breaths a min so hes just high as hell on codeine so naloxone is the answer.

 

[NoLollipops4U]

Assume I'm overthinking this one...

A 40 y/o f comes to physician; 1 yr history of crampy abdominal pain, diarrhea, rectal bleeding, passage of mucus. BMI 18. Diffuse abdominal tenderness, no rebound tenderness. A few diffuse ulcers on sigmoidoscopy. Most appropriate initial pharacoptherapy =?

A) Amoxicillin
B) Bismuth Subsalicylate
C) Loperamide
D) Octreotide
E) Sulfasalazine

Is the answer simply Sulfalazine for ulcerative colitis? My mind jumped to annorexia w/ laxative misuse.

Edit: 1 more, just to make sure I'm logick-ing this one right...

55 y/o M with chronic bronchitis, brought to ED after found unresponsive in bed. Bottles of Albuterol, ampicillin, codeine and theophylline on his bedside table. Temp 37.2C (99F), pulse 112/min, resp 6/min, bp 95/60. Acute treatment should include:

A) Flumazenil (no, benzos)
B) Fomepizole (no, toxic alcohols)
C) Hemodialysis (unlikely?)
D) Naloxone
E) Propanolol

My thought, is that Propanolol (or any b-blocker) could exacerbate underlying chronic bronchitis, especially since considering his bradypnea. Therefore, even though B-blockers are an antidote for theopylline, his respiratory depression is more pressing, and likely due to codeine overdose, which would best be treated by naloxone. Yes?

I got the UC question wrong too. I overthought it like you. Im just going to always assume rectum/sigmoid ulcers? Always UC haha

 

[Ankianki]

I got the UC question wrong too. I overthought it like you. Im just going to always assume rectum/sigmoid ulcers? Always UC haha

Try not to over think any question if possible. The answer is usually the most straight froward and least controversial one.

 

[Dr.G1989]

28 y.o.- lady, 18wks Gestation with palpitation. Serum total T4 is elevated. what do we do to confirm hyperthyroidism?

Choices were,
-FNA of thyroid (good for enlarged thyroid or nodule)
-Free T4
-Radio active iodine uptake check (contraindicated in Pregnancy)
-Serum Total T3 (can be falsely elevated bc of b-hCG stimulation of the gland)
-Thyroid antibodies- ( These are not wrong I suppose but not the best answer, considering that even if they are high, they finally lead to hyperthyroidism and may be lately to hypothyroidism...making it less favorable)

One one choice remains .

Yup you're right. Free T4

 

[bortenson]

Try not to over think any question if possible. The answer is usually the most straight froward and least controversial one.

Moderately off topic question... are the U-world practice tests as difficult as the other normal practice questions? Or do they mirror actual step 1 questions (for the record I'm usually btwn and 60 and 75% on Uworld 46 Q blocks, while my NBME's have been 85ish or higher).

If they're harder, I'm not going to prioritize them as highly. I'm more interested in finding questions in line with actual Step 1 since my test date is coming up.

 

[IceCastle]

Moderately off topic question... are the U-world practice tests as difficult as the other normal practice questions? Or do they mirror actual step 1 questions (for the record I'm usually btwn and 60 and 75% on Uworld 46 Q blocks, while my NBME's have been 85ish or higher).

If they're harder, I'm not going to prioritize them as highly. I'm more interested in finding questions in line with actual Step 1 since my test date is coming up.

I haven't taken my exam yet, but I have heard from other people that the Uworld assessments are pretty similar in difficulty to the real thing, but don't expect the curve to be as generous.

 

[DrTejIndia]

Does anyone know the answer to this one for nbme 17 :

47 year old woman with psoriasis comes for followup. At her last appointment she was given several topical creams, which must be applied in a specified sequence twice a day. No improvement is apparent in the current appointment. What would be the best way to begin the discussion of this patient's compliance with therapy ?

a. Did you use the creams twice daily ?

b. How many tubes did you use in the last month ?

c. How often did you skip treatments ?


d. Most people find it difficult to stick to a routine. How did you do ?

e. Using something twice daily can be difficult. I assume you are like most people who miss at least 10% of treatments.

 

[syoung]

Does anyone know the answer to this one for nbme 17 :

47 year old woman with psoriasis comes for followup. At her last appointment she was given several topical creams, which must be applied in a specified sequence twice a day. No improvement is apparent in the current appointment. What would be the best way to begin the discussion of this patient's compliance with therapy ?

a. Did you use the creams twice daily ?

b. How many tubes did you use in the last month ?

c. How often did you skip treatments ?


d. Most people find it difficult to stick to a routine. How did you do ?

e. Using something twice daily can be difficult. I assume you are like most people who miss at least 10% of treatments.

should be D...

 

[IceCastle]

Does anyone know the answer to this one for nbme 17 :

47 year old woman with psoriasis comes for followup. At her last appointment she was given several topical creams, which must be applied in a specified sequence twice a day. No improvement is apparent in the current appointment. What would be the best way to begin the discussion of this patient's compliance with therapy ?

a. Did you use the creams twice daily ?

b. How many tubes did you use in the last month ?

c. How often did you skip treatments ?


d. Most people find it difficult to stick to a routine. How did you do ?

e. Using something twice daily can be difficult. I assume you are like most people who miss at least 10% of treatments.

Answer is pretty much always something like D. Be empathetic and ask an open ended question.

 

[jggomeza]

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.

I chose metaplasia cos none of the others made much sense to me but I got it wrong.

 

[DrTejIndia]

@syoung @IceCastle

Are these confirmed answers based on your giving the actual test or are they your assumptions ?

I ask because I have seen quite a few KapQbank questions that say...NEVER ASSUME anything...start out with an open mind and have an open ended discussion..
dunno if it applies here...I suck at these questions..