NBME Q's

[Apoplexy__]

Just took a class-proctored NBME today (apparently it's only used by schools, so I don't think any of these Q's should be spoilers for any of the purchasable ones). I attempted looking the following Q's up online and in books, with no luck. I'd appreciate any help with the following:

Question 1: 2 year old kid experiences jaundice and bile duct fibrosis. His bile duct count kept decreasing as the disease progressed, and it mentioned something else about fibrotic changes. Then the question asked what the most likely sequelae was without treatment...I put "End-stage cirrhosis" although I didn't know what the diagnosis was. I'm thinking now it's possibly ARPKD...any other guesses?

Question 2: What are the advantages of doing a randomly controlled trial instead of a cohort study?
A. Fewer confounding factors
B. Lower Type 1 error rate
C. Lower Type 2 error rate
D. Lower requirement for statistical significance
I'm missing an answer choice, but any ideas?

Question 3: A bodybuilder comes in with chest pain that occurred 48 hours ago. CKMB is elevated. Question asked "what's the underlying cellular mechanism?" I was stuck between "hypertrophy" (from his skeletal muscles) and "reversible injury" (from his possible ischemic episode).

Question 4: A 13-yr old girl comes in for a routine visit with her mom. Nothing's wrong, no chief complaint, no findings, but you want to get a sexual history. Do you:
A) Ask the mother to leave
B) Ask the patient if she wants her mother to leave
C) Do the sexual history with the mom there

Question 5: A girl had some wound that was stitched up on her chin, where a small bump grew and was biopsied. The picture pretty clearly showed a couple of multinucleated giant cells, in a very strange-looking background of wavy, thread-like collagen-ish stuff. Probably granulation tissue. The question just asked you to identify the bump; I picked "granuloma" as the answer, but was unsure if the mere presence of MNGC's without any other information was singularly enough to call a granuloma.

Question 6: You're given a pedigree of a patient whose sibling has an autosomal recessive disease (but the patient doesn't). Then you're given the fact that the disease incidence in the equilibrated population is 1/40,000. The question asks what are the odds of the patient's kid having the disease. I used Hardy-Weinberg to say q = 1/200, p = 199/200, so therefore the probability of the patient's wife being a carrier is roughly 1/100. His chance of being a carrier is 1/2 since his parents must both be carriers.
--> Chance of them having the genes to produce a kid with the disease = ~ 1/200
--> Chance of them having that kid = ~ 1/800
Buuuuut...answer choices were:
A) Something more probable than 1/100
B) 1/100
C) 1/200
D) 1/600
E) 1/40,000

Sorry for the terrible format/presentation of these questions...kinda hard grabbing it from my memory. Any help appreciated.

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[Fatalis]

Just took a class-proctored NBME today (apparently it's only used by schools, so I don't think any of these Q's should be spoilers for any of the purchasable ones). I attempted looking the following Q's up online and in books, with no luck. I'd appreciate any help with the following:

Question 1: 2 year old kid experiences jaundice and bile duct fibrosis. His bile duct count kept decreasing as the disease progressed, and it mentioned something else about fibrotic changes. Then the question asked what the most likely sequelae was without treatment...I put "End-stage cirrhosis" although I didn't know what the diagnosis was. I'm thinking now it's possibly ARPKD...any other guesses?

Question 2: What are the advantages of doing a randomly controlled trial instead of a cohort study?
A. Fewer confounding factors
B. Lower Type 1 error rate
C. Lower Type 2 error rate
D. Lower requirement for statistical significance
I'm missing an answer choice, but any ideas?

Question 3: A bodybuilder comes in with chest pain that occurred 48 hours ago. CKMB is elevated. Question asked "what's the underlying cellular mechanism?" I was stuck between "hypertrophy" (from his skeletal muscles) and "reversible injury" (from his possible ischemic episode).

Question 4: A 13-yr old girl comes in for a routine visit with her mom. Nothing's wrong, no chief complaint, no findings, but you want to get a sexual history. Do you:
A) Ask the mother to leave
B) Ask the patient if she wants her mother to leave
C) Do the sexual history with the mom there

Question 5: A girl had some wound that was stitched up on her chin, where a small bump grew and was biopsied. The picture pretty clearly showed a couple of multinucleated giant cells, in a very strange-looking background of wavy, thread-like collagen-ish stuff. Probably granulation tissue. The question just asked you to identify the bump; I picked "granuloma" as the answer, but was unsure if the mere presence of MNGC's without any other information was singularly enough to call a granuloma.

Question 6: You're given a pedigree of a patient whose sibling has an autosomal recessive disease (but the patient doesn't). Then you're given the fact that the disease incidence in the equilibrated population is 1/40,000. The question asks what are the odds of the patient's kid having the disease. I used Hardy-Weinberg to say q = 1/200, p = 199/200, so therefore the probability of the patient's wife being a carrier is roughly 1/100. His chance of being a carrier is 1/2 since his parents must both be carriers.
--> Chance of them having the genes to produce a kid with the disease = ~ 1/200
--> Chance of them having that kid = ~ 1/800
Buuuuut...answer choices were:
A) Something more probable than 1/100
B) 1/100
C) 1/200
D) 1/600
E) 1/40,000

Sorry for the terrible format/presentation of these questions...kinda hard grabbing it from my memory. Any help appreciated.

1; assuming it was telling you about APCKD, cirrhosis is a long term comp, so i agree
2- A; remember this is CONTROLLED therefore a good researcher would have taken care of confounding factors before doing it
3- was irrev. an answer choice? An MI would lead to irrev change thats why you have the leak of CKMB.....then again CKMB can be from muscle as well. try to add more to the question, its really ambigious lol
4-A
5- was collagen an answer choice? thinking keloids
6- this is the 2/3 rule my friend
2/3 that he is a carrier [he doesnt have the disease but his parents are carriers] x the freq that he will mate with someone from the gen pop [1/200] who is a carrier so its 2x1/200 [we neglect the q bc its essentially 1] x 1/4 [chance of being AR]
= 1/600= D

 

[Missorleans]

I think question 2 is A, fewer confounding factors, that's the best answer I see up there anyway. Randomization reduces confounding.
Question 4, you ask the mother to leave the room. If you ask the girl if she wants her mother to leave, she might say no so as to not offend her mother. It's not fair to put her in that position, so you have to ask the mother to leave.
5, sounds like a granuloma to me, collagen and multinucleated giant cells.

 

[Apoplexy__]

Thanks to both of you. Really clears up the stats/ethics.

3- was irrev. an answer choice? An MI would lead to irrev change thats why you have the leak of CKMB.....then again CKMB can be from muscle as well. try to add more to the question, its really ambigious lol

Haha you know, that was actually the entire question. No other details given. I was pretty "wtf?" too.
Irreversible was an answer choice, I figured an MI was unlikely given he's fine now (48 hours later) and it didn't say anything about a particularly long duration of chest pain. Plus, you can get CKMB leak from reversible injury due to the increased membrane permeability.
I feel like they were testing whether CKMB can be falsely elevated by increased muscle mass or not...I didn't think it would, at least to a significant extent. So I put "reversible injury".

5- was collagen an answer choice? thinking keloids

5, sounds like a granuloma to me, collagen and multinucleated giant cells.

I don't think collagen was an answer choice. Bottom line is, I know I answered right if one can say multinucleated giant cells = granuloma, and that there is nothing else that can have MNGC's and not be a granuloma. You guys say yes?

6- this is the 2/3 rule my friend
2/3 that he is a carrier [he doesnt have the disease but his parents are carriers] x the freq that he will mate with someone from the gen pop [1/200] who is a carrier so its 2x1/200 [we neglect the q bc its essentially 1] x 1/4 [chance of being AR]
= 1/600= D

Lmao ahhhh I always f*ck that up with the 2/3 carrier probability in an asymptomatic offspring. Thanks man.

 

[Fatalis]

Thanks to both of you. Really clears up the stats/ethics.



Haha you know, that was actually the entire question. No other details given. I was pretty "wtf?" too.
Irreversible was an answer choice, I figured an MI was unlikely given he's fine now (48 hours later) and it didn't say anything about a particularly long duration of chest pain. Plus, you can get CKMB leak from reversible injury due to the increased membrane permeability.
I feel like they were testing whether CKMB can be falsely elevated by increased muscle mass or not...I didn't think it would, at least to a significant extent. So I put "reversible injury".




I don't think collagen was an answer choice. Bottom line is, I know I answered right if one can say multinucleated giant cells = granuloma, and that there is nothing else that can have MNGC's and not be a granuloma. You guys say yes?



Lmao ahhhh I always f*ck that up with the 2/3 carrier probability in an asymptomatic offspring. Thanks man.

now you wont mess it up ever again lol
with bodybuilders, ive seen a few questions where they want you to know that MI is a complication of steroid use; I am still leaning towards irrev injury