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* NBME 12 Qs.....
  haga - 03/17/12 05:43
  1. a 32 year old woman undergoes a laparascopic cholecystectomy after ultrasonography showed a thickened gallbladder wall and gallstones. The surgeon will be unable to inspect directly which of the following organs during this procedure?

A) Ileum
B) Jejunum
C) Pancreas
D) Stomach
E) Transverse Colon

2. A 67 year old woman has transient ischemic attacks. She cannot tolerate aspirin. Which of the following drugs is an appropriate alternative for cerebral infarction prophylaxis in this patient?

A) Acetaminophen
B) Clopidogrel
C) Dipyridamole
D) Ibuprofen

3. a 56 year old woman comes to the physician 1 week after she noted that her skin and eyes were yellow. She has had an unintentional 9 kg (20 lb) weight loss during the past 4 months. Physical examination shows scleral icterus and mild epigastric tenderness on palpation. Lab studies show:

Hb 12g/dl
Hct 35%
total bilirubin 8 gm/dl
ALK Phosphatase 456 U/L

An abdominal CT scan shows a mass at the head of the pancreas. Which of the following procedures is most likely to relieve this patient's jaundice?

A) Cholecystectomy
B) Placement of a percutaneous stent into the hepatic duct
C) Placement of a stent into the common bile duct
D) Placement of a stent into the main pancreatic duct
E) placement of a stent percutaneously into the cystic duct
F) placement of a transjugular intrahepatic portosystemic shunt

4. A study is conducted of breast cancer cell invasion of surrounding tissues and metastasis. Two breast cancer cell lines, in the presence and absence of macrophages, are analyzed. The macrophages are found to secrete a protein that is essential for invasion and metastasis. This protein is most likely which of the following?

A) E-Cadherin
B) Guanine nucleotide exchange factor
C) a2b1 integrin
D) metalloproteinase
E) Tyrosine Kinase

5. a 30 year old woman whose child has Duchenne muscular dystrophy comes to the physician because of progressive muscle weakness during the past 3 years. A muscle biopsy specimen obtained from the woman shows findings typical of hemizygous muscular dystrophy. Which of the following is the most likely explanation for the findings in this patient?

A) chromosomal translocation
B) maternal chromosome constitution 45,X
C) nondisjunction
D) unfavorable lyonization
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* Re:NBME 12 Qs.....
  fuzuli - 03/17/12 09:45
  - Q1: Jejunum, ileum, stomach, and transverse colon are peritoneal organs. Thus, the surgeon would be able to see them. Major parts of the pancreas (except the tail) are retroperitoneal, sp the surgeon would not see it within the peritoneal cavity. (Choice C)

- Q2: Clopidogrel is indicated as an anti-coagulant in patients who can't tolerate aspirin. (Choice B).

- Q3: Since the head of the pancreas is anatomically located next to the second and third parts of the duodenum, it obstructs the bile flow in the common bile duct. Therefore, a stent placed in the commmon bile duct would relieve the obstruction. Since the problem does not lie with the gallbladder, cholecystectomy or a stent placed in the cystic duct would not solve the problem. Similarly, placing a stent in the hepatic duct wouldn't solve the problem neither. Since bile doesn't flow through the main pancreatic duct, placing a stent there wouldn't improve this condition. Finally, TIPS is used for establishing venous flow, not bile flow (e.g. TIPS could be used in a patient who develops portal hypertension) (Choice C)

- Q4: Matrix metalloproteinases, which are secreted by macrophages, digest the extracellular proteins and produce a microenvironment that is more permissble for invasion and metastasis. Loss of E-cadherin and activation of a2b1 integrins are related with the invasive potential, but they are not secreted by macrophages. GNEF and tyrosine kinase is responsible for signal transduction, but again not secreted by macrophages. (Choice D)

- Q5: Since the boy has DMD, it means the mother is a carrier. So one of the X chromosomes she carries has the DMD mutation. If the normal X chromosome becomes inactivated in her muscle cells (so-called "unfavorable lyonization"), she would display the phenotypical features of the disease. (Choice D)
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* Re:NBME 12 Qs.....
  haga - 03/17/12 15:01
  Yeah number 4 is the one that gave me problems too. The right answer according to people who actually took the NBME is E-Cadherin. This is one of those questions that you're like....WTF are they asking??

There's a lot of questions like this in NBME 12.
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* Re:NBME 12 Qs.....
  vera16 - 03/17/12 15:02
  Please give me the block # and questions # to these NBME 12 questions...So, I can help you.  
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* Re:NBME 12 Qs.....
  fuzuli - 03/17/12 15:24
  @haga: E-cadherin is not secreted by macrophages. E-cadherin status of the tumor cells, not macrophages, is related with the metastatic potential.  
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* Re:NBME 12 Qs.....
  haga - 03/17/12 16:49
  I agree with you....E-cadherin is not secreted by macrophages.

But that is the right answer on the NBME.....go figure.
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* Re:NBME 12 Qs.....
  mr821 - 03/17/12 16:52
  ya i been confused abt tht one too. there were 2 question nabme 12 with similar style i never understood y e cadherin was this one cuz metalloprotinease made more sense to me.  
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* Re:NBME 12 Qs.....
  sribaabaa - 03/17/12 19:38
  can u plzzzzzz send me nbme12 to my  
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* Re:NBME 12 Qs.....
  vera16 - 03/17/12 21:17
  @sribaabaa: I thought I already sent you NBME 12 questions. Check your email.  
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* Re:NBME 12 Qs.....
  drmohanad - 03/17/12 21:31
  any can send me NBME 12 questions??

thx any way for all
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* Re:NBME 12 Qs.....
  subscap - 05/11/12 16:21
  can someone please send me the NBME 12 questions? thanks a lot!
my email is:
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