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!
--------------------------------------------
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

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[ewax]

Few more, any help is greatly appreciated!

1. A 15-year-old girl who recently emigrated from India is brought to the physician because of several lesions on her neck for 2 weeks. Physical examination shows a hypopigmented, hypoesthetic area over the left side of the forehead and 4-cm lesions on the neck. A biopsy specimen of a lesion shows acid-fast bacilli. Which of the following best explains why the causal organism results in dermal rather than in visceral infections?
A
) CO2 requirement
B
) Innate antibacterial compounds
C
) Lipid content
D
) Oxygen tolerance
E
) Temperature sensitivity (this is leporosy)

2. An 80-year-old man with type 2 diabetes mellitus is brought to the physician because a 2-month history of severe constipation. Use of over-the-counter laxatives has not relieved his symptoms. Abdominal examination shows distention. Colonoscopy shows no abnormalities. This patient most likely has dysfunction of which of the following nerves?
A
) Hypogastric
B
) Inferior rectal
C
) Pelvic splanchnic (loss of pns innervation)
D
) Perineal
E
) Sacral sympathetic


3. A 52-year-old man is brought to the physician by a social worker because his neighbors have reported that he has been confused and not taking care of himself. He has a 4-month history of diarrhea. Physical examination shows extreme muscle wasting, stomatitis, and a diffuse rash that is worse in sun-exposed areas. The patient is mildly disoriented and has poor long-term memory and paranoid ideation. Which of the following is the most likely diagnosis?
A
) Beriberi
B
) Pellagra (niacin def- triple d)
C
) Scurvy
D
) Wernicke syndrome
E
) Whipple disease
I totally missed this one, but cant definitively decide now b/t Whipples and Pellagra...

4. A 27-year-old woman comes to the physician because of fever, malaise, abdominal pain, and vaginal discharge for 4 days. Her last menstrual period ended 5 days ago. She had an ectopic pregnancy 1 year ago. Her temperature is 38.3°C (101°F). Abdominal examination shows bilateral lower quadrant tenderness with rebound and guarding. Pelvic examination shows cervical motion tenderness and bilateral adnexal tenderness. Her leukocyte count is 18,000/mm3. A pregnancy test is negative. Which of the following is the most likely diagnosis?
A
) Appendicitis
B
) Bacterial vaginosis
C
) Chancroid
D
) Diverticulitis
E
) Gonorrhea (vaginal discharge w s/s of PID)
F
) Herpes genitalis
G
) Trichomoniasis


5. A 62-year-old man develops a pericardial friction rub 3 days after an acute myocardial infarction. Which of the following is the most likely cause of the friction rub?
A
) Cardiac tamponade
B
) Fibrinous pericarditis (occurs about 1-3 days after MI)
C
) Left ventricular failure
D
) Mitral valve prolapse
E
) Purulent pericardial effusion

6. A 40-year-old woman comes to the physician because of a 1-year history of episodes of crampy abdominal pain, intermittent diarrhea, and rectal bleeding with passage of mucus. She is 173 cm (5 ft 8 in) tall and weighs 55 kg (120 lb); BMI is18 kg/m2. Abdominal examination shows diffuse tenderness with no rebound tenderness. Sigmoidoscopy shows a few diffuse ulcers. Which of the following is the most appropriate initial pharmacotherapy for this patient?
A
) Amoxicillin
B
) Bismuth subsalicylate
C
) Loperamide
D
) Octreotide
E
) Sulfasalazine (it is UC..use sulfasalazine to treat)
Is this not UC?

7. A 42-year-old woman comes to the physician because of a 1-month history of abdominal pain, especially after eating fatty meals. She is 180 cm (5 ft 11 in) tall and weighs 100 kg (220 lb); BMI is 31 kg/m2. Physical examination shows jaundice and tenderness of the right upper quadrant of the abdomen. An increase in which of the following liver functions is most likely in this patient?
A
) Cholesterol synthesis (increased cholesterol/bile acid =cholesterol stone)
B
) Conjugation of bilirubin
C
) Deamination of amino acids
D
) Glycogen synthesis
E
) Secretion of angiotensinogen
Thanks for the help!

 

[seminoma]

The one about paclitaxel on the IV catheter. The paclitaxel is to prevent intimal hyperplasia (and not neutrophil transmigration), right?

And is "intimal hyperplasia" the same thing as "epithelialization"?

 

[Tarrrrora]

21 -- A cholesterol synthesis
28 -- A neither. Confidence Interval includes 1.0 therefore not significant. in other words if RR 1.07 CI .75 to 1.15 that means RR could be between reduced risk (0.75) to increased risk (1.15)
30 -- C Heme synthesis. Cutaneous Uroporphobilogenoephofdof .. look up heme synthesis
45 -- 21 hydroxylase deficiency = hypotension, virilization female, inc 17-OHprogesterone
47 -- proliferative endometrial tissue ---> endometriosis

endometriosis came wrong..i think its endometrial hyperplasia as no dysmenorrhea is there

 

[Tarrrrora]

28 yr old female ,gravid 1 ,para 1 ,2 day h/o painful mass in right breast
delivered healthy newborn 3 wks ago and breastfeeding since then
temp-37 c
phy exam- 3 cm tender mass surrounded by erythema beneath areola,causal organism?

A.bacteriodes
B.e coli
C.haemophilus
D.STAPH a.
E.STREP. agalactiae

is it D. staph aureus?
p\overthinking lot

 

[seminoma]

28 yr old female ,gravid 1 ,para 1 ,2 day h/o painful mass in right breast
delivered healthy newborn 3 wks ago and breastfeeding since then
temp-37 c
phy exam- 3 cm tender mass surrounded by erythema beneath areola,causal organism?

A.bacteriodes
B.e coli
C.haemophilus
D.STAPH a.
E.STREP. agalactiae

is it D. staph aureus?
p\overthinking lot

Yep

 

[Tarrrrora]

50 yr old man,with pins an needles sensation around mouth hands and feet
involuntary contractions of hand and feet -wrist flexion and plantar flexion
P-80/min BP- 150/90
mild hyperreflexia

which electrolyte abnormality ?

is it sodium?

 

[Tarrrrora]

AIDs patient with TB.deficient in CD4 T lymphocytes on peripheral blood smear
patient likely to be deficient in following cellular components in tuberculous lesions-

langerhans giant cells or macrophages?
other options
eosinophils
fibroblasts
neutrophils

 

[seminoma]

50 yr old man,with pins an needles sensation around mouth hands and feet
involuntary contractions of hand and feet -wrist flexion and plantar flexion
P-80/min BP- 150/90
mild hyperreflexia

which electrolyte abnormality ?

is it sodium?

Sounds like hypocalcemia to me.

Answer choices?

AIDs patient with TB.deficient in CD4 T lymphocytes on peripheral blood smear
patient likely to be deficient in following cellular components in tuberculous lesions-

langerhans giant cells or macrophages?
other options
eosinophils
fibroblasts
neutrophils

Macrophages. Langerhans are cutaneous dendritic cells.

Tuberculous lesions = granulomas. Granulomas = CD4/Macrophages.

 

[Tarrrrora]

Sounds like hypocalcemia to me.

Answer choices?



Macrophages. Langerhans are cutaneous dendritic cells.

Tuberculous lesions = granulomas. Granulomas = CD4/Macrophages.

Sounds like hypocalcemia to me.

Answer choices?



Macrophages. Langerhans are cutaneous dendritic cells.

Tuberculous lesions = granulomas. Granulomas = CD4/Macrophages.

thanks !

options for the previous ones are-
bicarb
calcium
chloride
potassium
sodium

and please explain your answer thanks

 

[Tarrrrora]

44 yr old woman
f/u for PAP smear of atypical squamous cells
molecular diag test presence of viral E6 protein of HPV
PROTEIN- PROMOTES CELL GROWTH AND MALIGNANCY BY CAUSING CELLULAR P53
protein degradation. This degradation most likely begins when p53 protein-targeted to which of the following types of cellular enzymes?

lysine acetyltransferase
lysosomal protease
serine protease
tyrosine kinase
ubiquitin ligase

 

[seminoma]

thanks !

options for the previous ones are-
bicarb
calcium
chloride
potassium
sodium

and please explain your answer thanks

That's just what hypocalcemia looks like. It's straight out of FA.

 

[seminoma]

44 yr old woman
f/u for PAP smear of atypical squamous cells
molecular diag test presence of viral E6 protein of HPV
PROTEIN- PROMOTES CELL GROWTH AND MALIGNANCY BY CAUSING CELLULAR P53
protein degradation. This degradation most likely begins when p53 protein-targeted to which of the following types of cellular enzymes?

lysine acetyltransferase
lysosomal protease
serine protease
tyrosine kinase
ubiquitin ligase

Ubiquitin ligase. Question is asking you how intracellular proteins are degraded. Answer is Ubiquitin tagging for proteasomal degradation

 

[Tarrrrora]

That's just what hypocalcemia looks like. It's straight out of FA.

oh yes...thank you!

 

[Tarrrrora]

Ubiquitin ligase. Question is asking you how intracellular proteins are degraded. Answer is Ubiquitin tagging for proteasomal degradation

thanks found the ref of ubiquitin in Goljan

 

[KYdo]

60 yr old man who worked at a shipyard... path pic of asbestosis, fibrosis was most likely initiated by interaction of these fibers with...
a-alveolar capillary endothelial cells
b- alveolar mac
c- chondrocyte
d-ciliated columnar epithelial cell
e-cara cell
f-goblet cell
g- kulchitsky cell
h- squamous cell
I- type I pneumocyte
j- type II pneumocyte

 

[seminoma]

^macrophages

 

[seminoma]

Anyone remember that one question with a black and white cartoon drawing of lung alveoli that wanted you to pick the type 2 pneumocyte? Was it the cuboidal cell that looked like it had a few granules in it?

 

[cs24]

The one about paclitaxel on the IV catheter. The paclitaxel is to prevent intimal hyperplasia (and not neutrophil transmigration), right?

And is "intimal hyperplasia" the same thing as "epithelialization"?

Any more details on this question? I don't remember it at all

 

[seminoma]

Any more details on this question? I don't remember it at all

No, unfortunately . I don't remember the context, but it was literally just asking which cell in the lung secretes surfactant. Then it had a black and white picture (stick figure quality) with arrows labeled A, B, C, D. One arrow was pointing to an RBC in a capillary, another was pointing to a type 1 pneumocyte, another was pointing to a cuboidal cell with a pretty big nucleus and 3 small granule looking things, and the fourth arrow was pointing to a cell with an irregular shape (maybe they were supposed to be macrophage pseudopods?) and a kind of big nucleus.

It was such a ridiculous picture. Idk why they couldn't put a LM or EM in there instead of some drawing.

 

[cwwm]

No, unfortunately . I don't remember the context, but it was literally just asking which cell in the lung secretes surfactant. Then it had a black and white picture (stick figure quality) with arrows labeled A, B, C, D. One arrow was pointing to an RBC in a capillary, another was pointing to a type 1 pneumocyte, another was pointing to a cuboidal cell with a pretty big nucleus and 3 small granule looking things, and the fourth arrow was pointing to a cell with an irregular shape (maybe they were supposed to be macrophage pseudopods?) and a kind of big nucleus.

It was such a ridiculous picture. Idk why they couldn't put a LM or EM in there instead of some drawing.

Yup, the type II pneumocyte was the cuboidal cell. If I recall correctly, the endothelial cell was slightly above the type II pneumocyte and slightly below and to the right of the type II pneumocyte was the alveolar macrophage w/ an irregular membrane

 

[QualityProcess]

it was very similar to this. sorry about the img size

 

[cs24]

No, unfortunately . I don't remember the context, but it was literally just asking which cell in the lung secretes surfactant. Then it had a black and white picture (stick figure quality) with arrows labeled A, B, C, D. One arrow was pointing to an RBC in a capillary, another was pointing to a type 1 pneumocyte, another was pointing to a cuboidal cell with a pretty big nucleus and 3 small granule looking things, and the fourth arrow was pointing to a cell with an irregular shape (maybe they were supposed to be macrophage pseudopods?) and a kind of big nucleus.

It was such a ridiculous picture. Idk why they couldn't put a LM or EM in there instead of some drawing.

I meant the paclitaxel question haha

 

[pd1112]

@seminoma that's right, the paclitaxel is to prevent intimal hyperplasia. The two biggest risks with stents are thrombosis (tx dual anti platelet therapy) & restenosis (tx drug-eluting stents).

 

[Tarrrrora]

No, unfortunately . I don't remember the context, but it was literally just asking which cell in the lung secretes surfactant. Then it had a black and white picture (stick figure quality) with arrows labeled A, B, C, D. One arrow was pointing to an RBC in a capillary, another was pointing to a type 1 pneumocyte, another was pointing to a cuboidal cell with a pretty big nucleus and 3 small granule looking things, and the fourth arrow was pointing to a cell with an irregular shape (maybe they were supposed to be macrophage pseudopods?) and a kind of big nucleus.

It was such a ridiculous picture. Idk why they couldn't put a LM or EM in there instead of some drawing.

male newborn 28 wks gestation.given ventilatory support upto 80% O2 for next 72 hours
despite these efforts ,he dies from reps failure
most likely cause of death-adequate secretion of from which of the following labelled cells

ie surfactant producing cells as u were saying

 

[seminoma]

@seminoma that's right, the paclitaxel is to prevent intimal hyperplasia. The two biggest risks with stents are thrombosis (tx dual anti platelet therapy) & restenosis (tx drug-eluting stents).

And "intimal hyperplasia" means epithelialization of the stent right?

 

[Tarrrrora]

63 yr old man
6 mnth h/o exertional chest pain relieved by rest
smoked 1 pack of cigsdaily for 45 yrs
mild hypertension history
no meds
which of these lesions in LAD coronary is expected-
A.Calcified80% stenosis
B.embolism from left atrium
C fresh thrombus on 50% stenosis
D ruptured plaque pverlying 30% stenosis
E vasospastic 100% occlusion

i know its an easy one regarding stable angina but just confirming..it dint come in my incorrect but i don't remember what I had marked for it :/

 

[cs24]

63 yr old man
6 mnth h/o exertional chest pain relieved by rest
smoked 1 pack of cigsdaily for 45 yrs
mild hypertension history
no meds
which of these lesions in LAD coronary is expected-
A.Calcified80% stenosis
B.embolism from left atrium
C fresh thrombus on 50% stenosis
D ruptured plaque pverlying 30% stenosis
E vasospastic 100% occlusion

i know its an easy one regarding stable angina but just confirming..it dint come in my incorrect but i don't remember what I had marked for it :/

A. start showing symptoms at 75-80% stenosis or something like that. Rest wouldn't be stable angina either, all classic examples of acute coronary syndrome

 

[Tarrrrora]

A. start showing symptoms at 75-80% stenosis or something like that. Rest wouldn't be stable angina either, all classic examples of unstable

okay perfect.and last one sounds Prinzmetals angina
thanks!

 

[pd1112]

And "intimal hyperplasia" means epithelialization of the stent right?

You got it.

 

[ValentineLissar]

nv. I saw that my questions were posted answered elsewhere in the thread.

 

[Tarrrrora]

72 yr old man came with complaint of fatigue and weakness
Hb- 9.2 gm/dl, WBC 5400/mm3, platelets 350000/mm3 -(normal)
PBS was given (was it signifying hyperpigmented neutrophil)?

options given were-
aplastic anemia, CML, GI blood loss, beta thall major, VIt b12 deficiency

so I guess its vit b12 def if I interpretted the PBS correctly.
any input?

 

[KYdo]

^GI blood loss

 

[stepone2015]

72 yr old man came with complaint of fatigue and weakness
Hb- 9.2 gm/dl, WBC 5400/mm3, platelets 350000/mm3 -(normal)
PBS was given (was it signifying hyperpigmented neutrophil)?

options given were-
aplastic anemia, CML, GI blood loss, beta thall major, VIt b12 deficiency

so I guess its vit b12 def if I interpretted the PBS correctly.
any input?

Eldery + microcytic anemia = iron deficiency due to bleed is most common (if something else were going on, anemia of chronic disease would be more likely)

If it were macrocytic, it would be B12 due to pernicious anemia/achlorhydria (folate def possible, but less likely in this patient group, usually seen in alcoholics)

 

[Tarrrrora]

^GI blood loss

thanks!

 

[Tarrrrora]

Eldery + microcytic anemia = iron deficiency due to bleed is most common (if something else were going on, anemia of chronic disease would be more likely)

If it were macrocytic, it would be B12 due to pernicious anemia/achlorhydria (folate def possible, but less likely in this patient group, usually seen in alcoholics)

thanks for the detailed explaination!

 

[Tarrrrora]

hey ! does anyone have HY goljan notes ?I came across 46 pages 2004 version.
also are they helpful as I had read goljan somewhat long time back and cant remember much.
also if anyone has a good link to download the latest version,kindly drop in one here.thanks

 

[steponup]

hey guys thanks for all the help... exam is next week and i just did my last nbme today! i read all the responses, still have a few ones that werent discussed yet (or if they were they were deleted, or i must have missed, sorry!)- appreciate any help!

1) which spinal level has the sensory bodies for both periumbilical region of body wall and appendix?
a) t5
b) t10
c) t12
d) L1 - wrong
e) S2- this one? i thought nothing above L1 because thats like spleen/liver territory... maybe i'm thinking way off! watch it be like t-10 or something lol


2) 83 yr old man found bedridden and confused, no hx of meds. temp: 35.6, pulse 100, BP 85/50... bp unchanged from IV saline 1L; pulmonary artery catheder shows following: cardiac output - high, PCWP- low, systemic vasc resistance- low. which of the following is cause of hypotension?
a- early septic shock - sounds like it could be but why is the CO high, and there's no fever so i crossed it out
b- GI bleed
c- hypothyroidism
d- massive PE
e- silent myocard infarction

3) the man who went to africa and comes back with fever, headache, abdominal discomfort, but got all "appropriate vaccinations" before trip...
a- babesiosis - wrong
b- leishmaniasis
c-malaria - was this as simple as malaria? did i take "vaccination" to mean prophylactic therapy when really it didnt'... or did he get another strain of malaria? thanks for input!
d-toxoplasaosis
e- trypanosomiasis

4) person who is lightheaded after running 12 miles, pulse is 130, BP 80/60... what happens to sympathetic and parasymp activity?
-- basically i remember a similar q either in uworld or another nbme where a guy who was super nervous fainted bc his SNS was acting up to much that he got vasovagal syncope... tried to apply this here, as in SNS down, PNS up but it was wrong, overthought the question..

thank you all very much!!

 

[dfib slim]

hey guys thanks for all the help... exam is next week and i just did my last nbme today! i read all the responses, still have a few ones that werent discussed yet (or if they were they were deleted, or i must have missed, sorry!)- appreciate any help!

1) which spinal level has the sensory bodies for both periumbilical region of body wall and appendix?
a) t5
b) t10
c) t12
d) L1 - wrong
e) S2- this one? i thought nothing above L1 because thats like spleen/liver territory... maybe i'm thinking way off! watch it be like t-10 or something lol
It is t10, ha. Straight out of First Aid. Landmark dermatome.

2) 83 yr old man found bedridden and confused, no hx of meds. temp: 35.6, pulse 100, BP 85/50... bp unchanged from IV saline 1L; pulmonary artery catheder shows following: cardiac output - high, PCWP- low, systemic vasc resistance- low. which of the following is cause of hypotension?
a- early septic shock - sounds like it could be but why is the CO high, and there's no fever so i crossed it out
b- GI bleed
c- hypothyroidism
d- massive PE
e- silent myocard infarction
CO is high because afterload is decreased from the low systemic resistance. Fever isn't required.

3) the man who went to africa and comes back with fever, headache, abdominal discomfort, but got all "appropriate vaccinations" before trip...
a- babesiosis - wrong
b- leishmaniasis
c-malaria - was this as simple as malaria? did i take "vaccination" to mean prophylactic therapy when really it didnt'... or did he get another strain of malaria? thanks for input!
d-toxoplasaosis
e- trypanosomiasis
Not sure why. Nothing else fit.

4) person who is lightheaded after running 12 miles, pulse is 130, BP 80/60... what happens to sympathetic and parasymp activity?
-- basically i remember a similar q either in uworld or another nbme where a guy who was super nervous fainted bc his SNS was acting up to much that he got vasovagal syncope... tried to apply this here, as in SNS down, PNS up but it was wrong, overthought the question..
SNS up, PNS down. I just answered what the normal physiological response would be. Maybe the reason his BP is still low is because of dehydration?

thank you all very much!!

Answers in bold. None of them showed up on my incorrects.

 

[steponup]

thanks @dfib slim !

omg wow how did i miss t10 dermatome for umbilicus!! WOWOW this is a real facepalm moment, what a gimme question, too.
looks like i really overthought all of those. malaria and septic shock for sure... for the last one, that's what i put for that other question i was talking about, how frustrating.

need to remember not to do this on the real thing!

 

[cs24]

thanks @dfib slim !

omg wow how did i miss t10 dermatome for umbilicus!! WOWOW this is a real facepalm moment, what a gimme question, too.
looks like i really overthought all of those. malaria and septic shock for sure... for the last one, that's what i put for that other question i was talking about, how frustrating.

need to remember not to do this on the real thing!

for the septic shock one, remember old people are less likely to get fever than young healthy people.

http://www.ncbi.nlm.nih.gov/pubmed/8698997

 

[newhope2015]

I picked G. Its not in my incorrects.

Could anyone explain this one, please? 69 yo woman has weakness of her leg. also have decreased somatic sensation in the left foot... identify the lesion site.
I picked H and was wrong. Doesn't she has both motor and sensor lesions? Probably from stroke in ACA?

Thanks!

 

[newhope2015]

another one: a 62 yo man with alcohol induced liver disease develops massive ascites. what is the most appropriate diuretic treatment in addition to loop diuretics?
a) acetazolamide b) hydrochlorothiazide c)indapamide d)metolazone e)spironolactone
I chose C and got wrong. Aren't b, c, d all thiazides? Thiazides are used together with loop diuretics, synergistic? What's the deal of alcohol induced liver disease here?
Thanks!

 

[seminoma]

another one: a 62 yo man with alcohol induced liver disease develops massive ascites. what is the most appropriate diuretic treatment in addition to loop diuretics?
a) acetazolamide b) hydrochlorothiazide c)indapamide d)metolazone e)spironolactone
I chose C and got wrong. Aren't b, c, d all thiazides? Thiazides are used together with loop diuretics, synergistic? What's the deal of alcohol induced liver disease here?
Thanks!

Spironolactone is first line in addition to loops. Some studies suggest that spironolactone be used instead of loops because the natriuresis/diuresis is more significant with spironolactone.

Also, if you knew 3 of those are thiazides why did you pick one of them?

 

[seminoma]

Could anyone explain this one, please? 69 yo woman has weakness of her leg. also have decreased somatic sensation in the left foot... identify the lesion site.
I picked H and was wrong. Doesn't she has both motor and sensor lesions? Probably from stroke in ACA?

Thanks!

https://www.wikiwand.com/en/Paracentral_lobule

 

[newhope2015]

Spironolactone is first line in addition to loops. Some studies suggest that spironolactone be used instead of loops because the natriuresis/diuresis is more significant with spironolactone.

Also, if you knew 3 of those are thiazides why did you pick one of them?

Thank you, seminoma!
I kind of remember that indapamide has something unique, but forgot the detail. (it turns out to be not causing hyperlipdemia), so I think it might be good for pts with liver disease.

 

[newhope2015]

https://www.wikiwand.com/en/Paracentral_lobule

Thanks! I had thought the line between G and H is the central sulcus...

 

[seminoma]

Thank you, seminoma!
I kind of remember that indapamide has something unique, but forgot the detail. (it turns out to be not causing hyperlipdemia), so I think it might be good for pts with liver disease.

Could be, but check out uptodate or anything on pubmed. I got a very similar question wrong on a school exam. They described an edematous patient 2/2 cirrhosis and asked what diuretic to use. I picked furosemide. Answer was spironolactone. As soon as I read the NBME17 question I went looking for spironolactone as an answer choice because of that.

Thanks! I had thought the line between G and H is the central sulcus...

Yeah I remember looking at this question for a long time too. In the end I decided "H" was too far from the sulcus.. regardless of if it's the marginal sulcus or the central sulcus.

 

[rottweiler225]

"4. A 27-year-old woman comes to the physician because of fever, malaise, abdominal pain, and vaginal discharge for 4 days. Her last menstrual period ended 5 days ago. She had an ectopic pregnancy 1 year ago. Her temperature is 38.3°C (101°F). Abdominal examination shows bilateral lower quadrant tenderness with rebound and guarding. Pelvic examination shows cervical motion tenderness and bilateral adnexal tenderness. Her leukocyte count is 18,000/mm3. A pregnancy test is negative. Which of the following is the most likely diagnosis?
A
) Appendicitis
B
) Bacterial vaginosis
C
) Chancroid
D
) Diverticulitis
E
) Gonorrhea (vaginal discharge w s/s of PID)
F
) Herpes genitalis
G
) Trichomoniasis"


why isnt it trichomonas?

 

[ewax]

"4. A 27-year-old woman comes to the physician because of fever, malaise, abdominal pain, and vaginal discharge for 4 days. Her last menstrual period ended 5 days ago. She had an ectopic pregnancy 1 year ago. Her temperature is 38.3°C (101°F). Abdominal examination shows bilateral lower quadrant tenderness with rebound and guarding. Pelvic examination shows cervical motion tenderness and bilateral adnexal tenderness. Her leukocyte count is 18,000/mm3. A pregnancy test is negative. Which of the following is the most likely diagnosis?
A
) Appendicitis
B
) Bacterial vaginosis
C
) Chancroid
D
) Diverticulitis
E
) Gonorrhea (vaginal discharge w s/s of PID)
F
) Herpes genitalis
G
) Trichomoniasis"


why isnt it trichomonas?

Trichomonas won't cause signs and symptoms of PID (ie. abd pain, fever, etc.).

 

[seminoma]

"4. A 27-year-old woman comes to the physician because of fever, malaise, abdominal pain, and vaginal discharge for 4 days. Her last menstrual period ended 5 days ago. She had an ectopic pregnancy 1 year ago. Her temperature is 38.3°C (101°F). Abdominal examination shows bilateral lower quadrant tenderness with rebound and guarding. Pelvic examination shows cervical motion tenderness and bilateral adnexal tenderness. Her leukocyte count is 18,000/mm3. A pregnancy test is negative. Which of the following is the most likely diagnosis?
A
) Appendicitis
B
) Bacterial vaginosis
C
) Chancroid
D
) Diverticulitis
E
) Gonorrhea (vaginal discharge w s/s of PID)
F
) Herpes genitalis
G
) Trichomoniasis"


why isnt it trichomonas?

From an epi standpoint, gonorrhea is way more common than trichomonas. Also you don't typically associate trichomonas (or candida or gardnerella) with systemic illness.