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* NBME 15 questions
 #734890  
  sobe - 05/31/13 06:05
 
  Hey guys here is few i got wrong I have a weakness in respiratory section

1. 50 year old guy, 2 weeks progressive shortness of breath. pulse 90/min, RR 26 /min, BP 120/80
arterial Pco2 --> 30 mmhg
arterial Po2 --> 96 mmhg
arterial o2 content--->12 vol % --> n17-21
mixed venous Po2 ---> 36 mmhg
mixed venouse o2 content ---> 8 vol % --> n10-16

explain the finding
A anemia
B drug induced alveloar hyoventilation
c resident at high altitude
D sever regional mismatch alveolar ventilation and pulmonary cap perfusion
E voluntary hyperventilation

c is wrong

2. 32 year old in coma, drug overdose. pulse 68, RR 8/min shallow and bp 138/78 which one corresponds to pt?

ph po2 pco2 Hco3-

a 7.15 30 30 10
b 7.28 50 60 27
c 7.40 30 40 24
d 7.40 80 70 42
e 7.50 80 30 24

I think its b

3. 45 year old on Hydrochlorothiazide for HTN, feel dizzy when he gets up. pulse 75, RR 12/min and bp 130/85. What changes u see from supine to standing position?

venous return carotid sinus baroreceptor activity cerbral blood flow
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

f is wrong


4. 4 year old with 47 XY +21 has pancytopenia, lethargy, bruises pallor and fever. examination of bone marrow shows

a aplasia
b excess lymphoblast
c megaloblastosis
d parvavirus inclusion
e ringed sideroblast

a is wrong. its ALL so b

5. 72 year old with poor controlled HTN, sever abd pain for 2 hrs. pale and lethargic. p 124, rr 16, bp 95/60. S4 is present. Abd exam --> guarding, rigidity and pulsatile preumbilical mass. wat additional finding ?

a ankle brachial indices that are within normal limits
b AR
c asymmetric radial pulse
d bp reading that are higher in the left upper extremity than in the right
e decreased femoral pulses

6. 40 year old woman with breast cancer. progressive loss of peripheral vision to the left in both eyes. on examination she is unable to count fingers or detect finger movements on the left. on brain MRI the metastatic tumor to which part of brain?

a occipital
b optic chiasm
c optic nerve
d parietal lobe
e temporal lobe

e is wrong

7. 38 year old man w/ heartburn for 6 month. antacid don't work. diet didn't help. erosion and inflammation of squamous cells atdistal 6cm of esophagus. next best therapy.

a calcium carbonate
b cimetidine
c metoclopramide
d omeprazole
e sucralfate

think its cimetidine


8. Dexa scan of 65 year old woman shows decrease in bone density wat parameters are correct?

Osteoblast act. osteoclast act. kB aligand( RankL ) conc.

a up up up
b up dpwn up
c up down down
d down up up
e down up dpwn
f down down down

a is wrong

9. 52 year old man w/ sudden blindness of left eye. no pain. funduscopy of left eye show pale opaque fundus and bright red fovea centralis. dense scotoma of entire left visual field. Right eye is fine. 6 month later the left eye is still blind. If illuminate left eye wat happens in the right eye?

a. constrict bc the left optic tract is binocular
b constrict bc EW nucleus is bilateral
c dilation bc posterior commissioner is intact
d dilation bc the right superior cervical ganglion is intact
e no constriction b/c the left ciliary nerve has been permanently damaged
no constriction bc the retinal ganglion cells in the left eye have been destroyed

b is wrong but i think its e


10 . 66 year old woman w/ ovarian cancer. Cant urinate for 2 days. bilateral flan pain for 8 hrs. no supra pubic pain but bilateral costovertebral tenderness. foley catheter yields no urine. sono shows bilateral hydronephrosis. which one is present

a dec. glo oncotic p.
b dec int hydrostatic p
c dec tub hydrostatic p
d inc glo oncotic p
e inc int oncotic p
f inc tub hydrostatic p

a is wrong
 
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* Re:NBME 15 questions
#2893575
  millidiaz - 05/31/13 09:15
 
  1 dddd is wrong too, cant find the answer

2 BBBBB is correct, the patient has very slow respiration, so they are building up CO2 in the body causing it to increase above normal CO2 (33-44), also bc they are breathing slow, they are not taking in enough Oxygen, which drives the oxygen levels down below normal (75-105), bicarbonate level are normal, and the pH is acidic because of the increase in CO2

3bbbb is wrong too

4 BBBBB is correct, the child is under 5YO with down syndrome and ALL

5cccc is wrong, not sure

6AAAA is correct, lesion to the occiptial lobe causes L hempianopia with macular sparring

7 DDDDDD, omperazole is the first line treatment in hyperacidity, caused by gastric ulcers associates with helicobaacter pylori (fa)

8 DDDDD explanation: dexa scan is for osteoporsis, in this post-menopausal woman, there will be increase resortion due to decrease in estrogen levels. decrease formation of bone by osteoclasts. and RANK and RANK ligand interaction is increased (goljan)

9 not sure i got b wrong

10 not sure but c is incorrect as well

*****HOPE THIS HELPS, BUT ONE GOOD TURN DESERVES ANOTHER:

nbme 15 form 4,3,2,1

1. A 50 year old man comes to the ER bc of a 2 week hx of progressive shortness of breath. His pulse is 90/min respirations are 26/min, and BP is 120/80mm Hg. Physical exam shows no other abnormailties. Laboratory studies show : 30mmHg= arterial PCO2, 96mm Hg = arterial PO2, 12% vol = arterial O2 content, 36mmHg = mixed venous PO2, 8% vol= mixed venous )2 content. Which of the following is the likely explanation for these findings?

a) anemia
b) drug induced alveolar hyoventilation
c) residence at a high altitude
d) severe regional mismatching of alveolar ventilation and pulmonary capillary perfusion
e) voluntary hyperventilation

****i choose d and got is wrong

2. A 30 year old woman has had Hodgkin disease that was diagnosed 10 yrs ago and was treated with radiation and chemotherapy for 6 month period. She has remained in remission for 10 year. She now feels weak and has petechiae and ecchymoses. A diagnosis of acute myelogenous leukemia is made. Which of the following best explains this course of events?

a) hodgkin dz was not cured by the treatment and surviving neoplastic cells changed to acute leukemi
b) this patient had both Hodgkin dz and acute leukemia at the time of initial dx, but the leukemia remained dormant for several years
c) the patient has a genetic defect in the ability to repair DNA damage
d) the pt has inherited a predisposition to devo malignancies caused by EBV
e) therapy for hodgkin disease causes mutations in hematopoietic stem cells, and one mutant cell progresses to leukemia

*****i choose a, which is wrong, but i believe that it is e

3. 65 year old man with HTN volunteers to particiapte in a clinical trial of a newly developed loop diuretic. As part of the study, his acid-base/ volume status is monitored. AFter 3 days of rx, which of the following sets of findings is most likely in this patient?

a)met acidosis, vol contraction
b)met acidosis, no vol contraction
c)met alkalosis, vol contraction
d)met alkalosis, no vol contraction

****i choose a, but now i think it might be B

4. 56 year old woman is brought to the emergency department because of a 1 hour history of rapid heart rate and shortness of breath. She has a 2-month history of palpitaions. She is 165 cm (5ft5in) tall and weighs 55kg (121lb); BMI is 20kg/m. ECG shows ventricular tachycardia. The physician plans to initate treatment with an intravenous bolus dose of an antiarrrhythmic agent to attain an inital peak serum concentration of 10mg/L. The volume of distribution of the drug is 1.81L/Kg. Which of the following is the most appropriate loading dose of this drug for this patient (in mg)?

a)100
b)250
c)500
d)1000
e)1500

*****i choose aaaa which is WRONG

5. a 3 year old girl iss brought to the physician because of a 2 week history of diarrhea. Her temperature is 37.6 C , pulse is 70/min, respirations are 18/min and BP is 110/70. Physical exam shows generalized lymphadenopathy. a ct scan of the chest and abdomen shows enlarged LNs in the mesentry and para-aortic region. Examination of a lymph node biopsy specimen shows marked proliferation of histiocytes and numerous segmented neutrophils. Granulomata are absent and special stain shows numerous acid-fast bacilli, which are subsequently identified as Mycobacterium avium intracellulare. Serum studies show normal concentrations of IgA, IgG, IgM, B lympho, T lympho, and CD4+ and CD*+ T lymphocytes. This patient has likely defective function or expression of which of the following protein?

a) Class I MHC
b) interferon gamma receptor
c) interleukin-2 (IL2) receptor
d) leukocyte function-associated antigen-1
e) NADPH oxidase

***** c is incorrect

6. a 54 year old man comes to the physician bc of increasing pain for the past 2 months and a 9kg weight loss over the past 3 months. he is jaundiced. A CT scan of the abdomen shows a mass in the head of the pancrease with considerable extension to the stomach and biliary system. He is at greatest risk for devo which of the following conditions

a) bipolar
b) major depressive
c) memory impairment
d) personaity change
e) schizophreniform

******d is incorrect

 
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