NBME 13 discussion - mr821

[ArchivalUser]

First of all i got 217/470. 10 point below then what i got before. I would say at the level of hardness its the same is the previous one. i think in every nbme block there are question u might never heard of. I also think the grading has changed or i could be wrong.

For example world if you get about 65% of the answers right your 3 digit is around 230. Nbme if you get 65% right you might not even pass. Atleast that wht i think.

Im open to discussion here with anyone who is intrested.

Some of the question:

1. 55 yo recovered from stroke 2 years ago who lives alone. he is at increased risk of

Agrophobia , major depressive order, OCD, PTSD

I picked agrophobia (wrong) thinking he is prolly scared of getting another attack so dont want to be alone but i guess the answer is MDS

2. 16 yo who is controlled DM who skip on his insulin injection. how shd u approach
A - giving urself insulin injection can be difficult, wht is like it for u

b- i get the feeling u have not been taking it regulerly, wud u like to arrange some training for u
c - poorly controlled DM have trouble giving them self injection, do u have tht problem
d - you seem to have missed ur shots, is that ur prob

Might be B not sure

sequencing of mitochindria DNA show G to A transition. this results in added A;T base pair to the 3 end of TRNA and shortening of c loop. which is the effect of mutation.
a - decrease protein synthesis
b- increase protein synthesis
c- decrease replication
d- increase mrna stability
e - increase replication

[ArchivalUser]

1. i put PTSD and got it wrong lol..so maybe major depressive disorder no idea...
2. i put A and am pretty sure i got it right
3. A decrease protein synthesis

[ArchivalUser]

1) I would say Major Depressive
2) A opens the discussion up as to how he feels and can get to root cause of skipping
b basically accuses him might not get the answer as to why he skipped.
3) Not sure i would guess C ? what the correct for this ?

[ArchivalUser]

here's a couple more if anyone doesn't mind answering

A previously healthy 42-year-old Asian woman is brought to the emergency department because of a 24 hour history of nausea, vomiting, and progressive lethargy. She has smoked 1 pack of cigarettes daily for 25 years and drinks four glasses of wine daily. She uses high-dose acetaminophen daily for headaches. She not use illicit drugs. She is 155cm (5ft 1 in) tall and weighs 50 kg (110 lb); BMI is 21 kg/m2. She is responsive to painful stimuli. Initial lab studies show increased hepatic aminotransferase. Which of the following effects of alcohol most likely contributed to this patient’s condition?
A) Decreased generation of N-acetyl-p-benzoquinoneimine
B)I ncreased glucuronidation
C) Increased heptic glutathione stores
D) Increased sulfation
E) induction of cytochrome p450


A 25-year-old woman undergoes a radical mastectomy with removal of the axillary lymph nodes on the left side. After the operation, she develops painful edema of the left upper extremity. Which of the following therapies is most likely to decrease the swelling in this patient?
A)Applicant of heat
B) Compression sleeve
C) Diuretic therapy
D) Exercise therapy
E) Passive movement


An autopsy is done on a 46-year-old woman who died of adenocarcinoma of the colon. Examination of the neck shows a 5-cm, rounded mass next to the bifurcation of the carotid artery. A section of the mass is shown in the photomicrograph. Immunohistochemsitry of the section is positive for snaptophysin, chromogranin and neuron-specific enolase. Electron microscopy shows numerous electron-dense, membrane-bound neurosecretory granules. Examination of the adrenal glands shows no masses. Which of the following is the mostly likely diagnosis? (A picture was shown of god knows what)
A) Metastatic colonic adenocarcinoma
B)Metastatic squamous cell carcinoma of the larynx
C) Papillary carcinoma of the thyroid gland
D) Paraganglioma
E) Parathyroid adenoma


A 63-year-old man comes to the emergency department 30 minutes after the sudden onset of right-sided chest pain and shortness of breath that began after a 10-hour drive in his truck. The pain is more severe with inspiration. He does not smoke cigarettes. His pulse is 110/min, and respirations are 32/min. The lungs are clear to auscultation. Which of the following findings is most likely on ventilation-perfusion lung scans?
A) Absence of perfusion in some areas that are ventilated
B) Absence of ventilation in some areas that are perfused
C) Absence of ventilation-perfusion mismatching
D) Decreased perfusion gradient from the apices to the bases of the lungs
E) Increased ventilation-perfusion ratios at lung bases compared with those at the apices

[ArchivalUser]

1. major depressive disorder - it's in kaplan behavioral science
2. A - not accusing him, but trying to get it out of him
3. A

Increase glucoronidation. acetametophin toxicty

I put compression but i honestly have no idea.. will try to find out

Paraganglioma. most are asymptomatic. located along blood vessels and derive from NC.

Pretty sure this is A. pulm. embolism. block in blood vessel. Decreased in perfusion but ventilation is not affected.

[ArchivalUser]

Awesome! thanks so much

[ArchivalUser]

are you sure abt increase glucoronidation, cuz i thought to increase NABP u need induction of P450

[ArchivalUser]

oh yeah! you are right. induction of p450.
ethanol is an inducer. oops I'm sorry! damn. got that one wrong haha

[ArchivalUser]

I got a couple more if you guys don't mind!!!


1. A 15 year old boy has intracranial neoplasm’s, mental retardaion and seizures associated with tuberous sclerosis complex, an autosomal dominant disorder. His 41 year old mother ishealthy but has angiofibromas, which are benign skin lesions characteristic of tuberous scleoris comples. Which of the following best explains the findings in the boy and his mother?
A) Alternate paternity
B) Anticipation
C) Paternal germline mosaicism
D) Reduced penetrance (wrong)
E) Variable expressivity

2. A 64 year old woman comes to the physician because of a 6 month history of heartburn and difficutly swallowing solid and liquid. She has not had nausea or vommitting. She also has a 2 year history of pain and swelling of her wrists and hands. She has not seen a physician in 5 years. She does not smoke. She takes no medications. PE shows no wrinkles on the face and neck. He vitals are within normal limits. There is synovial thickening of the wrists bilaterally. A photograpsh of the left hand is shown. Abdominal exam shows no abnormalities. Which of the following sets of findings is most likely on the esophageal manometry?

Esophageal Peristalisis LES Tone

A. Increased Increased
B. Increased Decreased
C. Normal Increased
D. Normal Decreased (wrong)
E. Decreased Increased
F. Decreased decreased


3. A 62 year old man is brought to the emergency department because of a 3 hour history of progressive difficulty breathing and mild left shoulrder pain. His symptoms began after he ran of several flights of stairs. He has poorly controlled hypertensio and mild angina pectoris. He has smoked one half pack of cigarettes daily for 40 years. He appears uncomfortable and has labored breathing. Diffurse crackles, ronchi, and scattered wheezing are heard on auscultation of the posterios lung fields. His arterial PO2 is 58 mmHg. Which of the following is the most likely diagnosis?

A. Cardiac tamponade
B. Pnuemotnitis (wrong)
C. Pneumothorax
D. Pulmonary Edema
E. Pulmonary embolism

A 40 year old woman is brought to the Emergency department 30 minutes after sustaining server chest injuries in a motor vehicle accident. Despite appropriate treatment she dies 1 hour lates. She had 25 year history of a well controlled seizure disorder. A phtograph of a coronal section of the brain obtained at autopsy is shown. Which of the following is the most like diagnosis?

A. Glioblastome Multiforme (wong)
B. Herpes simplex encephatlitis
C. Mesiald temporal sclerosis
D. Neonatal ischemic stroke
E. Vascular malformation

A 76 year old man is admitted ot the hospital because of a 2 week history of persistan urinary tract infections. He is a 165 cm and weighs 55 kg, BMI is 20. The physician plans to initiate treatment. A component of the intiatl treatment includes IV bolus of an antibiotic to attain an initial peak serum concentration of b mg/L. The volume of distribution of the antibiotic is 0.35L/kg. Lab studies show a 24 hour urine creatinine clearance within the referance range. Which of the following is the most approprate loading dose of this dring for this patient (in mg)?
A) 25 (wrong)
B) 50
C) 100
D) 150
E) 200

A study is conducted to assess the effectiveness of Vitamin C in preventing common colds in children. Patiens are randomly assigned to receive either vitamin c or no intervention. Oputcome events (common old) are reported tby the parents on a monthly basis for 1 year. Results show that those taking vitamin C have fewer colds compared with those who received no intervention (p

[ArchivalUser]

A study is conducted to assess the effectiveness of Vitamin C in preventing common colds in children. Patiens are randomly assigned to receive either vitamin c or no intervention. Oputcome events (common old) are reported tby the parents on a monthly basis for 1 year. Results show that those taking vitamin C have fewer colds compared with those who received no intervention (p