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* NBME 5 Block 3 - please help
  iqbalian01 - 04/15/10 23:55
  Q1) when they ask “how long after the FIRST measurement (in hours)”, does this mean after the first measurement from 240ng/mL to 202ng/mL OR does it mean after the first half life?
If they are asking after the first hour when a measurement is recorded , then it would be 24 hrs
If they are asking after the first half life, then it would be 20hrs.
So confused on the wording…?

Q26) answer is ‘d’, right?

Q32) I chose ‘a’? please explain answer.

Q37) so you would not medicate the patient (option ‘e’)?

Q42) since the lesion is 10mm in size, then you would go for cryotherapy. But if it is > 2cm, then it would be excision. Right?

Q50) want to make it gender identity disorder?

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* Re:NBME 5 Block 3 - please help
  sweety123 - 04/16/10 01:02
  Iqbalian 1st measurement is 240 so the ans is definetely 20 hrs

Yes it is Hypoactive sexual desire - cant be depression or adjustment or dysthmia as no signs of depression Aversion is totally avoids all sexual contact

32) ans shud be B first streptomycin acts on 30 S subunit do option c and d are ruled out now consider option A and B if u wud see line 2 and 3 and the corresponding response with and without streptomycin it will explain the ans in those who are resistant S12 and sensitive S5 the activity with or without strep does not change but the one below the activity is affected so the ans is probably B

37) I am not sure abt this too but I guess symptoms onset in the night in an alzheimers patient so maybe B is the right option as anxilytics cannot be used in elderly patients due to the risk of respiratory depression due to them in anycase maybe BB but even I am confused over it

42) where did u find this criteria for basal cell carcinoma treatment is it appropraite
i thought u excise with Moh's Surgery

50) yes it is GID - abnormal identification as a female
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* Re:NBME 5 Block 3 - please help
  iqbalian01 - 04/17/10 17:14
  thanks sweety123

Q1) i got it...thanks

Q32) is the answer not 'a'? if you see where it says "activity with streptomycin" is 61 and you follow that to S12 & S5, the S12 is "R" (resistant) while the S5 is "S" (sensitive) so then it would be the S5 subunit that streptomycin interacts with...right????

Q37) okay, so i guess it's answer 'b', then.

Q42) if found it at one is another one because i cannot find the first site...Treating Basal Cell Carcinoma with Simple Excision
This procedure involves surgical excision of the lesion including a margin of normal skin. This method is preferred for larger lesions (>2cm) on the cheek, forehead, trunk, and legs. The advantage of this treatment is that it is quick and inexpensive. However, the difference between normal and cancerous tissue must be judged with the naked eye.

Q30) i have a question on this one too. how do you choose between options 'a' & 'b'?

according to wikipedia: Common adverse reactions in patients taking opioids for pain relief include: nausea and vomiting, drowsiness, ITCHING (option 'b'), dry mouth, miosis, and constipation.[9]

according to another site the side effects are: # Muscle spasticity
# Shallow breathing
# Pinpoint pupils
# Bluish skin
# Bluish fingernails
# Bluish lips
# Gastrointestinal spasms
# Weak pulse
# Reduced blood pressure
# Constipation
# Slowed breathing
# Cold skin
# Clammy skin
# Seizures
# Drowsiness

so the cyanosis (blue skin, fingernails) is the option 'a'.

so i'm confused on this one.

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* Re:NBME 5 Block 3 - please help
  iqbalian01 - 04/18/10 16:47
  please help with Q32 & Q30.  
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* Re:NBME 5 Block 3 - please help
  yeabiruh - 04/18/10 18:33
  q 32...streptomycin is antmicrobial drug which inhibits protein synthesis by interfering with the binding of formyl-methionyl-tRNA to the 30S subunit in bacterias.30S subunit has two group of proteins S12 and S5 ...So in the question we gonna eliminate choices C and D because they belong to the 50s ribosomal subunit ....Then we have to choose b/n a and b .....

Streptomycin to block the initiation of protein synthesis it has to bind either to S12 or S5 part of the 30S ribosomal subunit...Hence when streptomycin binds to either S12 OR S5 we have to see a marked decrease in count per minute (cpm) compared to the the cpm of the ecoli (which has no streptomycin added ) ,given that these proteins are sensitive for the action of streptomycin(not resistant)...

So let us c one by one
Ecoli 1----S12 Sensitive..S5 sensitive...difference between cpm(count per minute)--22
Ecoli 2----S12 Resistant ...S5 sensitive ..difference between cpm ...........................1
Ecoli 3....S12 Sensitive ...S5 resistant.....difference between cpm............................28
Ecoli 4...S12 Resistant ...S5 resistant.......difference between cpm........2
Ecoli 5...S12 Sensitive ....S5 sensitive.......difference between cpm......15
Ecoli 6...S12 SENSITIVE ...S5 sensitive.....difference between cpm...21
Ecoli 7...S12 sensitive .....S5 sensitive....difference between cpm...22

as we can c we get marked difference in the cpm only when S12 is sensitive (focus on Ecoli 3) from this my thinking is S12(the binding site for streptomycin on 30S ).....
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* Re:NBME 5 Block 3 - please help
  yeabiruh - 04/18/10 18:45
  q30....from kaplan pharmacology (2008) page 152...
acute opioid analgesic toxicity : classic triad
pinpoint pupil,respiratory depression(cyanosis) and coma....

as u said there are so many signs and symptoms of the toxicity but the classic triad are the ones on choice AAAAA
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* Re:NBME 5 Block 3 - please help
  rose18 - 04/18/10 18:47
any1 plz mention for me what the equation u used for
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* Re:NBME 5 Block 3 - please help
  yeabiruh - 04/18/10 19:10
  q37...this a case of agitated older patient (DELIRUIME) and here is a nice summary of how to treat this

In short there are nonpharmacological and pharmacological treatments...more of the non pharmacological one

Non-pharmacologic strategies
for delirium
• Provide a clock and calendar,Ask family members or volunteers to help
reorient the patient by cueing them,Ask family members to bring familiar
belongings to help the patient to adjust to a new environment,Avoid overstimulation or understimulation,Promote sleep with a quiet environment,
soothing music, and appropriate lighting, Optimize the patient’s senses—use their
eyeglasses and hearing aids

IF Pharmacological treatment IS required antipsychotics are recommended not anxiolytics.

The use of physical restraints is a risk factorfor delirium. Their use should be minimized
as they have not been shown to reduce injuries.
Hence I go for BBBB ,thank you guys ....
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* Re:NBME 5 Block 3 - please help
  iqbalian01 - 04/18/10 19:15
  wonderful yeabiruh! Q32 makes sooo much more sense now and i agree with your answers.
thanks again for all your help. :)
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* Re:NBME 5 Block 3 - please help
  yeabiruh - 04/18/10 20:01
  q 42....In the question stem excisional biopsy is already explained ...and it is one of the treatment modalities for nodular basal cell carcinoma ....hence what would be the answer after the patient had the surgery.....i am confused.....  
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* Re:NBME 5 Block 3 - please help
  yeabiruh - 04/18/10 20:11
  Q26---I go for hypoactive sexual desire disorder as u said

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