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?!
-------------------------------------------
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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[syoung]

@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..

based on how we learned ethics at our school. plus there are ethics books galore on USMLE step 1...
and based on what you just said, we are having an open mind and having an open discussion w/ pt on that cream ?

 

[PillmillPhil]

Can anyone help me with this one...

49. A 12 yo boy is swimming in a mountain stream. he is immersed up to his neck n 60F water for 20 mins. which of the following sets of physiologic changes is most likely to occur in this boy?

Central Blood volume / ADH / ANP
A up/ up/ up
B up/up/down
C up/ down/ up
D up/ down/ down
E down/ up/ up
F down/ up/ down
G down/ down/ up
H down/ down/ down

Are we to assume the boy swallowed a ton of water???
I didnt understand what they were asking, so I put F at first which is incorrect.

Is A the corret answer?

 

[syoung]

imagine you were in 60F water, what would happen?

 

[skimd33]

Anyone know this one?

18. A 45-year-old man comes to the physician because of yellow skin for 4 days. He lost his job 10 days ago, and he has been drinking eight to ten 12-ounce cans of beer daily since then. Physical exam shows jaundice. The liver is tender to palpation. Serum studies show:
Total bilirubin 5.9
Alk phos 210
AST 110
ALT 69
y-Glutamyltransferase 35 (N=0-30)
Histologic examination of a liver biopsy specimen will most likely show which of the following?
A) alpha1-antitrypsin globules
B) Glycogen
C) Hemosiderin
D) Lipofuscin
E) Mallory hyaline

 

[Ankianki]

@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..

I answered it that way and it didn't come up.

 

[blueshockey]

Can anyone help me with this one...

49. A 12 yo boy is swimming in a mountain stream. he is immersed up to his neck n 60F water for 20 mins. which of the following sets of physiologic changes is most likely to occur in this boy?

Central Blood volume / ADH / ANP
A up/ up/ up
B up/up/down
C up/ down/ up
D up/ down/ down
E down/ up/ up
F down/ up/ down
G down/ down/ up
H down/ down/ down

Are we to assume the boy swallowed a ton of water???
I didnt understand what they were asking, so I put F at first which is incorrect.

Is A the corret answer?

I'm not entirely sure what the correct answer is; but my rationale for this question is that if he's in cold water, his peripheral arterioles are going to intensely vasoconstrict, leading to increased central blood volume. As a result of this increased central blood volume, ADH is likely to be decreased (owing to the relative blood volume increase, i.e. your body thinks it has enough volume), and by the same logic, ANP would also be increased owing to the relatively hypervolemic state (atria thinks it has more fluid). I'm just spit-balling here so I'm sure someone has a more informed opinion than me

 

[blueshockey]

Anyone know this one?

18. A 45-year-old man comes to the physician because of yellow skin for 4 days. He lost his job 10 days ago, and he has been drinking eight to ten 12-ounce cans of beer daily since then. Physical exam shows jaundice. The liver is tender to palpation. Serum studies show:
Total bilirubin 5.9
Alk phos 210
AST 110
ALT 69
y-Glutamyltransferase 35 (N=0-30)
Histologic examination of a liver biopsy specimen will most likely show which of the following?
A) alpha1-antitrypsin globules
B) Glycogen
C) Hemosiderin
D) Lipofuscin
E) Mallory hyaline

My guess would be E here. AST:ALT ratio is greater than 1.5 would tend to indicate alcoholic hepatitis --> mallory hyaline. First Aid says this is with "sustained, long-term consumption" so I don't know if 12 beers a day for a week and a half will fit the bill or not but that's my guess.

 

[skimd33]

A healthy 70-year-old woman has participated in a longitudinal study of the effects of aging on performance during pulmonary function tests for the past 50 years. She has undergone a complete set of tests, including arterial blood gas analysis, every 5 years. Which of the following sets of changes represents this woman now compared with her results at the age of 20 years?
Residual volume: up, down, or no change
Arterial PO2: up or down
Alveolar-arterial PO2 difference: up or down

 

[Dr.G1989]

A healthy 70-year-old woman has participated in a longitudinal study of the effects of aging on performance during pulmonary function tests for the past 50 years. She has undergone a complete set of tests, including arterial blood gas analysis, every 5 years. Which of the following sets of changes represents this woman now compared with her results at the age of 20 years?
Residual volume: up, down, or no change
Arterial PO2: up or down
Alveolar-arterial PO2 difference: up or down

RV- UP
Arterial PO2- Down
Alv-Art PO2 Diff- UP

 

[Clumpofstuff]

Can anyone help me with these ones:

The marathon runner who gets lightheaded and the question was about the nervous system state
I know its not symp down and Parasymph up


Gynecomastia and hCG
What is the mechanism?

 

[IceCastle]

Can anyone help me with these ones:

The marathon runner who gets lightheaded and the question was about the nervous system state
I know its not symp down and Parasymph up


Gynecomastia and hCG
What is the mechanism?

I'm not 100% that this is correct, but this is how I thought of it.

hCG has the same alpha unit as LH, FSH, TSH. Increase in hCG -> increase in LH -> more testosterone (via Leydig cells) -> more estrogen (via aromatase in adipose tissue and testis) -> gynecomastia

 

[IceCastle]

double reply on accident

 

[NoLollipops4U]

@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..

I got the question correct as well. He's right

 

[Meatspin]

any input on how nbme 17 results have compared to actual exam scores?

 

[Aizee]

any input on how nbme 17 results have compared to actual exam scores?

Hey. A friend of mine scored 5 points higher than NBME 17.
He got 232 in NBME and scored 237.
I am waiting for my result. Will update you next week

 

[Aizee]

Can anyone help with this? I'm stuck between B and D. Also, if possible, please provide an explanation validating thought-process logic.
View attachment 191510

the Answer is B.
ok so TPMT breaks down 6-MP. So if there is a homozygous for low activity of TPMP... he wouldn't break down as much 6-MP as a normal person would. Hence the level of 6-MP would increase.
So for treatment of ALL.. we would give decreased amount of 6-MP as it won't be broken down by one of the pathways.

 

[Doct2be]

Thank you Aizee!

 

[Charmer]

I'm not entirely sure what the correct answer is; but my rationale for this question is that if he's in cold water, his peripheral arterioles are going to intensely vasoconstrict, leading to increased central blood volume. As a result of this increased central blood volume, ADH is likely to be decreased (owing to the relative blood volume increase, i.e. your body thinks it has enough volume), and by the same logic, ANP would also be increased owing to the relatively hypervolemic state (atria thinks it has more fluid). I'm just spit-balling here so I'm sure someone has a more informed opinion than me

that is the right rationale!

 

[Charmer]

Can I please know one thing? if you know it folks...do the folks in the exam administration check our real exam scores or do they counter proof our NBME self assessment scores and give us average scores????? I mean It is hard not to suspect things like that given and learning that the NBME-SA is a good predictor of our scores...AS far as I have heard ...Does anyone share my suspicion ????

 

[everyday123]

.

 

[blueshockey]

Please help!!

x amount of healthy women observed for multiple years. Fam Hx taken from each volunteer. want to see if # of family members who previously received breast ca dx correlates w/ incidence of future cancer in this population. design?
- case series, cohort, crossover, cross-sectional (wrong), randomized control

marathon runner. once glucose stores depleted, which organ besides liver releases new glucose?
-adrenals (wrong), kidney, pancreas, stomach, thyroid gland

To me the first one sounds like a cohort study (can be prospective which follows people to see if they develop a disease with a given exposure or risk factor- in this case the risk factor would be family history). It isn't a case series because they aren't tracking the natural history of a dz, it isn't a crossover because that applies to drugs, cross-sectional is at a specific point in time (these women were followed over years), and I don't see anything indicating a randomized control design. I'm pretty sure the second one is the kidney (kidney is another organ besides the liver which can facilitate a modest amount of gluconeogenesis).

 

[neissin]

Can someone plzz help wd these Qs?
1. 6 wk girl wd 6 day h/o vomitting small amounts of milk 2-3 times/d. appears well. 50th percentile for wt and height. PE normal
A)eosophageal spasm
B) gut malrotation
C)immature LES
D)neuromusc abnormality of oesophagus
E)pyloric stenosis(wrong)
F)TEF

2.in 15 y girl, which one is major factor to predict compliance with photoprotection
A)ability to tan
B)advice of physician
C)desire to prevent sunburn
D)F.H of skin cancer
E)concern about premature skin aging(wrong)
F)peers using sunscreen

3. In HPV, E6 protein degrades p53 through targetting p53 to which cellular enzymes?
A)lysosomal protease
B) ubiquitin ligase
C) serine protease
D)tyrosine kinase(wrong)
E) lysine acetyltransferase

4.15 yo f wd 1 day h/o redness and painful skin following sunbathing. she used sunblock every few hours. P/E shows severe erythem of back and extremities. there are no blisters. Dx?
A)allergic reaction to sun(wrong)
B)first degree burn
C)2nd degree burn
D)3rd degree burn
E) rhus dermatitis

5. that linkage analysis Q wd pedigree tree?

6. lamellar body Q wd figure?

Thanks in advance!!

 

[synecdoche]

Answers in the quote

Can someone plzz help wd these Qs?
1. 6 wk girl wd 6 day h/o vomitting small amounts of milk 2-3 times/d. appears well. 50th percentile for wt and height. PE normal
A)eosophageal spasm
B) gut malrotation
C)immature LES - lucky guess on my part
D)neuromusc abnormality of oesophagus
E)pyloric stenosis(wrong)
F)TEF

2.in 15 y girl, which one is major factor to predict compliance with photoprotection
A)ability to tan
B)advice of physician
C)desire to prevent sunburn
D)F.H of skin cancer
E)concern about premature skin aging(wrong)
F)peers using sunscreen

3. In HPV, E6 protein degrades p53 through targetting p53 to which cellular enzymes?
A)lysosomal protease
B) ubiquitin ligase
C) serine protease
D)tyrosine kinase(wrong)
E) lysine acetyltransferase

4.15 yo f wd 1 day h/o redness and painful skin following sunbathing. she used sunblock every few hours. P/E shows severe erythem of back and extremities. there are no blisters. Dx?
A)allergic reaction to sun(wrong)
B)first degree burn
C)2nd degree burn
D)3rd degree burn
E) rhus dermatitis

5. that linkage analysis Q wd pedigree tree?
2,3

6. lamellar body Q wd figure?
The diagram of the alveoli? The type 2 pneumocytes have a more cuboidal shape, as opposed to the macrophages which were really irregular

Thanks in advance!!

 

[synecdoche]

Regarding the question about ubiquitin mediating degradation of p53 - is there something special about p53/other things that ubiquitin tags, or does ubiquitin just do everything? For some reason I thought it was more specific to cytoskeleton components.

Also, overthinking this one I think: "34yo man is evaluated after becoming lightheaded during a marathon on a hot day. Pulse 130 BP 80/60. What is happening to sympathetic activity (increase, decrease, or no change) and parasympathetic activity (increase or decrease)?"

 

[BoneDoc91]

Exam is in three days, would love some input on these. Thanks!

60 y/o male comes to ED, sudden onset acute abd pain and tenderness, nausea, vomiting, blood diarrhea 2 hours ago. History of cirrhosis and HCC. During surgery half of small intestine is found to have dark purple red hemorrhage appearance
A. Bacterial enterocolitis
B. Mesenteric venous thrombosis
C. Necrotizing enterocolitis
D. Pseudomembranous colitis
E. Ulcerative colitis
F. Whipple disease

55 year old woman, left flank pain and gross hematuria. 12cm mass on lower pole of kidney. Angiogram show hypervascular mass
A. Wilms tumor
B. Papillary transitional cell carcinoma
C. Renal cell adenocarcinoma
D. Renal cell adenoma
E. Squamous cell carcinoma

Male newborn, macrocephaly and poor skill mineralization and shortened extremities with misshaped long bones and several fractures during birth
A. chondroitin sulfate
B. collagen
C. elastase
D. glycosidase
E. glycosyltransferase
F. sulfatase

10 years after gastrectomy, 60 year old has difficulty walking. Mentation and cranial nerve function is normal. Spasticity in arms and legs, impaired proprioception in feet, increased muscle stretch reflex in arms and knees, absence of muscle stretch reflex in ankles, bilateral extensory plantar reflexes. What vitamin def?
A. A
B. B1
C. B6
D. B12
E. Biotin
F. C
G. E
H. K2
I. Retinol

34 year old man lightheaded after running 12 miles of a marathon on a hot day. Pulse 130 and BP 80/60 (arrow question)

Was this increased efferent sympathetic and decreased efferent parasympathetic?

32 year old man , 3 month history of swelling and tenderness of both breasts. Receiving TSH and corticosteroid replacement therapy after surgical removal of a pituitary adenoma. Given hCG injections. What is the binding site and action of hcg that causes gynecomastia
A. adrenal gland --> 17-hydroxyprogest. Synthesis
B. breast --> direct stimulation
C. Liver --> testosterone metabolism
D. Pituitary --> prolactin
E. Testicle --> estradiol (would the hcg cause increased test synthesis --> converted to estradiol?)

63 year old woman brought to ED with 2 day history of fever, adb tenderness, and painful urination. She is agitated. She was tearing up the breakfast menus because she found them too confusing. She is highly educated. Husband says she doesn't behave that way at home. What is the patients mental status
A. amnesia
B. delirium
C. dementia
D. mild cognitive impairment
E. occult cerebral infarct

26 year old woman comes to the physician 5 weeks after birth of her child. She worries constantly that the infant is ill and wakes him up 10-14 times every night to make sure he is well. She has had no crying spells or problems with appetite. She is worried that she will infect the infant with her germs and washes her own hands 30 times per day. 2 months prior to delivery she worried about people breaking into her house and checked the lock on the front door three to four times a night. What is the treatment

A. alprazolam
B. haloperidol
C. lithium carbonate
D. methylphenidate
E. phenelzine
F. sertraline

 

[PL198]

what is everyone's advice for what NBMEs to do? assuming 16 and 17, but would you rather do both UWSA or 2 NBME? basically planning on doing 1 a week over a 4 week period in dedicated

 

[Doct2be]

Exam is in three days, would love some input on these. Thanks!

60 y/o male comes to ED, sudden onset acute abd pain and tenderness, nausea, vomiting, blood diarrhea 2 hours ago. History of cirrhosis and HCC. During surgery half of small intestine is found to have dark purple red hemorrhage appearance
A. Bacterial enterocolitis
B. Mesenteric venous thrombosis (was a complete guess on my test but I got it right. I was stuck between this and necrotizing enterocoloitis)
C. Necrotizing enterocolitis
D. Pseudomembranous colitis
E. Ulcerative colitis
F. Whipple disease

55 year old woman, left flank pain and gross hematuria. 12cm mass on lower pole of kidney. Angiogram show hypervascular mass
A. Wilms tumor
B. Papillary transitional cell carcinoma
C. Renal cell adenocarcinoma (classic sign of palpable mass, hematuria, and flank pain)
D. Renal cell adenoma
E. Squamous cell carcinoma

Male newborn, macrocephaly and poor skill mineralization and shortened extremities with misshaped long bones and several fractures during birth
A. chondroitin sulfate
B. collagen (this is a case of osteogenesis imperfecta; they are looking for type-I collagen defect)
C. elastase
D. glycosidase
E. glycosyltransferase
F. sulfatase

10 years after gastrectomy, 60 year old has difficulty walking. Mentation and cranial nerve function is normal. Spasticity in arms and legs, impaired proprioception in feet, increased muscle stretch reflex in arms and knees, absence of muscle stretch reflex in ankles, bilateral extensory plantar reflexes. What vitamin def?
A. A
B. B1
C. B6
D. B12 (total gastrectomy causes parietal cell deficiency, which relates to an inability of Intrinsic factor production and decreased ability for vitamin B-12 uptake in the ileum)
E. Biotin
F. C
G. E
H. K2
I. Retinol

34 year old man lightheaded after running 12 miles of a marathon on a hot day. Pulse 130 and BP 80/60 (arrow question)

Was this increased efferent sympathetic and decreased efferent parasympathetic?

32 year old man , 3 month history of swelling and tenderness of both breasts. Receiving TSH and corticosteroid replacement therapy after surgical removal of a pituitary adenoma. Given hCG injections. What is the binding site and action of hcg that causes gynecomastia
A. adrenal gland --> 17-hydroxyprogest. Synthesis
B. breast --> direct stimulation
C. Liver --> testosterone metabolism
D. Pituitary --> prolactin
E. Testicle --> estradiol (would the hcg cause increased test synthesis --> converted to estradiol?)

63 year old woman brought to ED with 2 day history of fever, adb tenderness, and painful urination. She is agitated. She was tearing up the breakfast menus because she found them too confusing. She is highly educated. Husband says she doesn't behave that way at home. What is the patients mental status
A. amnesia
B. delirium (old person most likely has UTI. Old people with UTI have been known to become delirious)
C. dementia
D. mild cognitive impairment
E. occult cerebral infarct

26 year old woman comes to the physician 5 weeks after birth of her child. She worries constantly that the infant is ill and wakes him up 10-14 times every night to make sure he is well. She has had no crying spells or problems with appetite. She is worried that she will infect the infant with her germs and washes her own hands 30 times per day. 2 months prior to delivery she worried about people breaking into her house and checked the lock on the front door three to four times a night. What is the treatment

A. alprazolam
B. haloperidol
C. lithium carbonate
D. methylphenidate
E. phenelzine
F. sertraline (she has OCD; you give a SSRI to help with her obsessive rituals)

I highlighted the ones that are confirmed correct from my test. I hope this helps.

 

[BoneDoc91]

Man, those questions were pretty straightforward. Need to stop overthinking it . Thanks!

 

[Doct2be]

No problem. I got some easy questions wrong as well for over-thinking. The test writers for NBME have become smart when writing these questions because they know the "classical" signs we are looking for and they reverse it by replacing it, for example, with a female instead of a male or disease in a specific age that makes no sense.

 

[synecdoche]

what is everyone's advice for what NBMEs to do? assuming 16 and 17, but would you rather do both UWSA or 2 NBME? basically planning on doing 1 a week over a 4 week period in dedicated

I used UWSA1 as my baseline, pre-dedicated. Then took a bunch of NBMEs. Going to try to fit in UWSA2 shortly before the real thing, because some MS3s at my school said it "felt" more like the real thing, even though the projected score is a little less accurate.

 

[Dr.G1989]

6. D (Posterior Pituitary (Diab Insipidus))
29. B (New splice site)
37. D (HSV 2) at least from the history (multiple small tender blisters (vesicles)). Does the micro show multinucleated giant cells? Or Intranuclear inclusion bodies??
39. D Sympathize with the patient, he already has lung cancer telling him smoking is a risk is pointless at this point, plus chances are he knows that. So that rules out B, C, and E. Also don't give the patient false hope, which eliminates A. Doesn't exactly make sense since he's had hemoptysis, but its the best answer (i got this correct)

 

[usmlestep1close]

6. D (Posterior Pituitary (Diab Insipidus))
29. B (New splice site)
37. D (HSV 2) at least from the history (multiple small tender blisters (vesicles)). Does the micro show multinucleated giant cells? Or Intranuclear inclusion bodies??
39. D Sympathize with the patient, he already has lung cancer telling him smoking is a risk is pointless at this point, plus chances are he knows that. So that rules out B, C, and E. Also don't give the patient false hope, which eliminates A. Doesn't exactly make sense since he's had hemoptysis, but its the best answer (i got this correct)

Thank you dr. AG1989.

 

[neissin]

Answers in the quote

Thanks. That helps.
Do you remember the answer to that Q with figure of brain's broadmann areas? The case had both motor and sensory dysfunction. So which one to choose on figure? precentral or postcentral gyrus?

Thanks.

 

[Meatspin]

21 - A
28 - A; CI includes 1 so there isn't a statistically significant difference between the two
30 - C; porphyria cutanea tarda
45 - C
47 - E; not entirely positive about that one
48 - C
9 - C
18 - C - inhibits IL-2 production
19 - B
32 - D; HELLP --> hemolysis --> schistocytes
12 - A; gamma hemolytic --> enterococcus
16 - D; never make an excuse
23 - C
33 - D

Your post is probably going to get deleted

 

[AnilaMed]

Thanks in advance for any help.

- 16 year old girl has 3 day fever, nonproductive cough, fatigue. temp 100.9F, pulse 88, resp 18/min, bp 102/70 mmHg. Exam has pale conjunctiva. Chest x-ray bilateral interstitial infiltrations. Blood drawn spontaneously agglutinates. What is the antibody isotype that caused the agglutination?
A. igA B. igD C. igE d. IgG E. igM

- 32 female, gravida 2, para 1 at 7 weeks gestation comes to ED because of vaginal bleeding for 3 days and severe left abdominal pain for 18 hrs. Abdominal exam shows severe direct and rebound tenderness with guarding in the left lower quadrant. THe cervical os is closed. Serum betahCG is 6000. Ultrasound shows empty uterus. Diagnosis?
Abrupto placentae, ectopic preg, hydatidiform mole, incomplete abortion, placenta previa, preterm labor, threatened abortion, vasa previa

-Asymptomatic 52 yr woman comes to physician because of hot flashes. Her menses have been irregular for the past 6months. Cause of her symptoms?
decreased hypothalamic secretion of gonadotropin releasing hormone
excessive conversion of androstenedione to estrone
excessive production of adrenal androgens
failure of the anterior pituitary to secrete androgens
failure of the anterior pit to secrete gonadotropins
failure of the ovaries to secrete 17b-estradiol

- previously healthy 42 yr man is brought to the ED because of 5 hr history of fever, chills and severe pain and swelling on his left arm. Got scratched when repairing fence. Appears confused. 104F temp, pulse 140min, respiration 25/min, bp 71/38. Left arm shows edema and erythema in the area of the scratch. Patients symptoms attributed to systemic release of which?
IL1 and IFN alpha
IL1 and IFN gamma
IL1 and TNF alpha
IL4 and IFN alpha
IL4 and IFN gamma
IL4 and TNF alpha

 

[Doct2be]

Thanks in advance for any help.

- 16 year old girl has 3 day fever, nonproductive cough, fatigue. temp 100.9F, pulse 88, resp 18/min, bp 102/70 mmHg. Exam has pale conjunctiva. Chest x-ray bilateral interstitial infiltrations. Blood drawn spontaneously agglutinates. What is the antibody isotype that caused the agglutination?
A. igA B. igD C. igE d. IgG E. igM (this is a classic case of cold agglutination; at least that's how I reasoned it on my exam)

- 32 female, gravida 2, para 1 at 7 weeks gestation comes to ED because of vaginal bleeding for 3 days and severe left abdominal pain for 18 hrs. Abdominal exam shows severe direct and rebound tenderness with guarding in the left lower quadrant. THe cervical os is closed. Serum betahCG is 6000. Ultrasound shows empty uterus. Diagnosis?
Abrupto placentae, ectopic preg (increased beta HCG, lower quadrant pain, and woman of child-bearing age is the clinical picture for this), hydatidiform mole, incomplete abortion, placenta previa, preterm labor, threatened abortion, vasa previa

-Asymptomatic 52 yr woman comes to physician because of hot flashes. Her menses have been irregular for the past 6months. Cause of her symptoms?
decreased hypothalamic secretion of gonadotropin releasing hormone
excessive conversion of androstenedione to estrone
excessive production of adrenal androgens
failure of the anterior pituitary to secrete androgens
failure of the anterior pit to secrete gonadotropins
failure of the ovaries to secrete 17b-estradiol (She is menopausal thus the ovaries are failing to produce estrogen. A reduced estrogen caused increased FSH and LH. Not to mention, vasovagal (hot-flashes) are indicative of in this presentation.

- previously healthy 42 yr man is brought to the ED because of 5 hr history of fever, chills and severe pain and swelling on his left arm. Got scratched when repairing fence. Appears confused. 104F temp, pulse 140min, respiration 25/min, bp 71/38. Left arm shows edema and erythema in the area of the scratch. Patients symptoms attributed to systemic release of which?
IL1 and IFN alpha
IL1 and IFN gamma
IL1 and TNF alpha (these are the classic acute-phase (inflammatory) reactant cytokines. They are composed of IL-1, IL-6, and TNF-alpha)
IL4 and IFN alpha
IL4 and IFN gamma
IL4 and TNF alpha

Hope this helps. The answers are highlighted in bold with a brief explanation. They are confirmed because I got them right on my exam

 

[Dr.G1989]

21 - A
28 - A; CI includes 1 so there isn't a statistically significant difference between the two Not D?? A risk of 0.66 for a procedure producing post op infection...those procedures are probably no useful in clinical setting right? (not sure on this one)
30 - C; porphyria cutanea tarda
45 - C
47 - E; not entirely positive about that one (Got this right, its Endometriosis)
48 - C
9 - C
18 - C - inhibits IL-2 production Isn't this E---Why would there be increased interleukin production??
19 - B
32 - D; HELLP --> hemolysis --> schistocytes
12 - A; gamma hemolytic --> enterococcus
16 - D; never make an excuse
23 - C
33 - D

Your post is probably going to get deleted

 

[Meatspin]

28 - the risk for a procedure producing post op infection wouldn't be 0.66. The relative difference in risk between the two is 0.66. For example procedure A could be 2/1000 and procedure B could be 3/1000. Both procedures risk of producing an infection is ≤0.3%, but the relative risk of procedure A to procedure B is 0.66. If the relative risk is 1, there is no statistical difference between the two and since 1 is included in the CI the answer is A.

18 - I misread it and just put the first answer choice with T lymphocytes in it. You're correct it is E.

 

[sammyade]

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

??

I got this one right It's basement membrane

 

[sammyade]

View attachment 191776
I would really appreciate any help with these

I got this right...... D

 

[sammyade]

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

For SURE. ..... B

 

[sammyade]

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

 

[sammyade]

More questions. would appreciate your help.

 

[sammyade]

I'm not 100% that this is correct, but this is how I thought of it.

hCG has the same alpha unit as LH, FSH, TSH. Increase in hCG -> increase in LH -> more testosterone (via Leydig cells) -> more estrogen (via aromatase in adipose tissue and testis) -> gynecomastia

Icecatle@ please answer the brain picture one precentral or post central gyrus

 

[sammyade]

40 YEAR OLD MAN WITH INTERSTIAL PUL FIBRISIS HAS A GREATER MAX. EXP FLOW RATE THAN PREDIDTED WHICH OF THE FOLLOWING EXP THE FINDING?

A. hypercapnic brobchodilation
b. hyperinflation of lung
c. hypoxiv bronchodialtion
d. inc radial traction of airway
e. inc surfactant secretion

 

[IceCastle]

Longhorn, concerning your questions, here are what I think are the answers, but I took the NBME about three weeks ago and I can't remember for sure.

B (look up conjugated vaccines)
A (The relative ratio confidence interval crosses 1, therefore the results are not statistically significant)
B I'm pretty sure this was discussed in this thread elsewhere, but an elevated TOTAL t4 can be expected during pregnancy because estrogen increases TBG, but free T4 should not be elevated unless hyperthyroidism is present.
E This was discussed already I believe
C I remember that this is C.
D Open ended, emphatic approach

 

[IceCastle]

Icecatle@ please answer the brain picture one precentral or post central gyrus

I'm not sure what this is referring to.

40 YEAR OLD MAN WITH INTERSTIAL PUL FIBRISIS HAS A GREATER MAX. EXP FLOW RATE THAN PREDIDTED WHICH OF THE FOLLOWING EXP THE FINDING?

A. hypercapnic brobchodilation
b. hyperinflation of lung
c. hypoxiv bronchodialtion
d. inc radial traction of airway
e. inc surfactant secretion

It's radial traction. This exact question is a Uworld question that will explain it well.

 

[synecdoche]

Icecatle@ please answer the brain picture one precentral or post central gyrus

I think the answer was precentral, though I'm not sure why, because I think the patient had both motor and sensory deficits in a bunch of locations.

 

[V14]

A 50 yr-old man who has smoked 2 packs of cigarettes a day for 34 yrs has experiencesd increasing SOB on exertion, chronic cough productive of thick sputum, and frequent episodes of wheezing. The anteroposterior diameter of his chest is increased. Which of the following lab abnormalities is expected?
A-decreased blood PCO2
B-Increased blood HCO3
C-Increased blood pH
D-Increased urinary excretion of HCO3
E-Increased urinary pH

An 8 yr old boy is brought to the physician by his parents because of disruptive behavior. They say, “He is easily distracted, constantly interrupts us while we are talking, and seems to be always moving. His teacher says he is always talking “ Physical examination shows no abnormalities. If drug therapy is indicated, administration of a drug with which of the following mechanisms of action is most appropriate.
A-antagonism at B-adrenergic receptors
B-Blockade of voltage-gated Na channels
C-Enhanced action of GABA at GABAa receptors
D-Increased release of dopamine and NE (?)
E-Selective inhibition of uptake of serotonin at nerve terminals

A 45 yr old man comes to the physician because of intermittent bloody diarrhea and abdominal pain during the past month. Sigmoidoscopy and rectal biopsy specimens show inflammatory bowel disease. A trial of a monoclonal antibody preparation is begun. The antibody in the preparation is most likely to be directed against which of the following components?
A-Bradykinin
B-C3a
C-Class I MHC antigens
D-Fibrin
E-PGE2
F-Tumor necrosis factor (infliximab, I suppose :/)

A 60 yr old woman is brought to the physician 3 hrs after the sudden onset of pain of her rt ankle. She has a 4 yr hx of gradually increasing serum Cr concentrations. She began furosemide therapy 1 month ago for pedal edema. Current meds also include glipizide for type 2 DM. Her pulse is 120/min, resp 25/min, and BP 150/100mmhg. Physical exam shows exquisite tenderness to palpation of the rt ankle joint. Analysis of joint fluid aspirate shows negatively birefringent crystals. Sensation to pinprick is decreased in the feet. The patient is at increased risk for which of the following complications of the underlying process causing the joint findings?
A-Cholelithiasis
B-Nephrolithiasis
C-Osteoarthritis
D-Osteoporosis
E-Pathologic fx

Any help with these questions would be appreciated!

 

[V14]

A 42 yr old woman w/ a 3 yr hx of an intermittent facial rash, including the forehead, eyelids, nose and cheeks. She says that the rash seems to be getting worse since she moved from NY to Florida last year. She notes that she has always blushed easily. Spicy foods also precipitate a flushing reaction that seems to exacerbate the rash. Occasionally, her face burns and stings, and her skin feels dry. Physical exam shows erythema over the nose and cheeks, w/ scattered telangiectasias and a few papules. dx?
A-Acne vulgaris
B-Carcinoid syndrome
C-Pityriasis rosea
D-Rosacea
E-Seborrheic dermatitis