NBME 19 questions and answers

i actually got this question wrong putting libido and nocturnal errections w/o change, so im not sure what the answer is.

 

Really? wow. i got that question wrong, w/o changes was my second guess. we will have to wait for some one to tell me the correct answer. Thanks for the info.

 

Libido is decreased. Nocturnal erections are normal. Sorry, I missed this on your key.

 

um.. i got that wrong. that was my first choice actually.

 

-_-

Sorry to jump the gun. I'm looking back on my exam now. I know I got it right, because it's not in my wrong answers. I would still argue it's normal libido. My logic is that he wouldn't really be coming in complaining of an erection problem if his libido was down. They usually tell you straight out libido is down. And nocturnal emissions should not be affected. That was my first thing before the libido. I also posted the key to my class, who looked at it, and just conferring with other members now tell me that libido and nocturnal emissions should both be normal.

Anyone else?

 

You guys made quite a few mistakes. Please don't post wrong answers if you're just guessing.

50) 2 wk old full term female newborn develops pale stools and progressive jaundice. Nuclear scans show no excretion of bile. A1AT deficiency ruled out. Liver biopsy shows inflammation and proliferation of small bile ducts and increased portal fibrosis. If not treated, what develops?
End-stage cirrhosis

9) 48 yo woman fatigue, weakness, loss of appetite, and weight loss. Serum PTH increased. Xray of skeletal system shows generalized osteopenia with subperiosteal resorption of bone within the phalanges. MOA?
Paracrine stimulation of osteoclasts by osteoblasts

11) Determine ACE inhibitors superior to CCB in preventing renal disease progression in pt with T1DM. whats advantage of randomized controlled trial versus prospective cohort study?
Better control for confounding variables

26) Study function of voltage-gated sodium channel. A mutant form that inactivates more rapidly than normal is developed. Whats effected?
Decreases the amplitude of the action potential

34) 65-year-old man has a prostatectomy and lymph node dissection for adencocarcinoma of the prostate. Which of the following is involved in the GRADING of this neoplasm?
D - Tumor cell appearance and arrangement (the only answer choice related to GRADE, not stage)

35) 66 yo man inability to maintain erection. Fatigue and difficulty sleeping and concentrating. Cerebral infract 3 months ago with right hemiparesis that gradually improved. Physical exam normal. What other findings?
Decreased libido, normal nocturnal erections

 

"Explain that a feeding tube is difficult to monitor and may not prevent aspiration" is wrong, I chose it and got it wrong.

It's most likely "follow only the wishes of the wife" since the question says she feeds him meals several times weekly. She'd probably know most about the pt. wishes.

 

I agree i might have got some questions wrong. And those were corrected. You must been reading old answers. Also 35) Decreased libido, normal nocturnal erections was my answer choice, and it was wrong. 50) End-stage cirrhosis, my answer was Budd-chiari and it did not show up as wrong answer. For answers i wasn't sure i put a "?" behind questions and welcome others input. Then i change accordingly. I never claimed all the answers are correct. Obviously you didn't make any mistakes and aced it. So why dont you post the next NBME 20 instead. Dont be a DICK. I didn't put down answers i got wrong. And this is posted so others can check and input and learn. Not you being critical and leaving an ASSHOLE comment.

 

I chose this option and it was wrong. In my opinion the right answer is advice the family to make a decision based of what they think is the patient wishes.

 

↑
BLOCK 3



8) 45 yo man gradually worsening heartburn. Physical exam unremarkable. Endoscopy shows stomach with thickened nodular mucosa w/ no discrete ulcerations. Steiner silver stained gastric biopsy shown. Abnormality commonly associated w/ what disease?
Peptic ulcer Disease?

9) 48 yo woman fatigue, weakness, loss of appetite, and weight loss. Serum PTH increased. Xray of skeletal system shows generalized osteopenia with subperiosteal resorption of bone within the phalanges. MOA?
PTH mediated production of transforming growth factor beta 1?
Confirmed
Not sure how to explain the second one, but the first one is H. pylori and commonly causes peptic ulcer disease

Can someone please explain the answer for the first question. How can it be Peptic ulcer disease with no discrete ulcers? Thanks

 

BLOCK 2

I got this answer right (I just doubled checked to make sure). The right answer is decreased cell death in thymic cortex. BCL-2 codes for an anti-apoptotic protein. So, if it is always expressed it will reduce cell death in thymic cortex in the mice reciving the genetically modified cells.

 

BLOCK 2

I got this answer right. The correct answer is
CO: decresed CVP: increased
I think the patient has CHF so CO is decresed and CVP increased

 

Block 2

I also got this right. The correct answer is end-stage cirrhosis.

 

BLOCK 3

I actually got this question wrong.I marked E and it was wrong. I think that the right answer is D because in the proximal tubule Na+ (and H2O) is reabsorbed with glucose and in exchange with H+. Both processes not requiring energy. In the basolateral side Na+ is exchanged with K+ with Na+/K+ ATPase that requires energy.

 

conan said: ↑
BLOCK 3



8) 45 yo man gradually worsening heartburn. Physical exam unremarkable. Endoscopy shows stomach with thickened nodular mucosa w/ no discrete ulcerations. Steiner silver stained gastric biopsy shown. Abnormality commonly associated w/ what disease?
Peptic ulcer Disease?

9) 48 yo woman fatigue, weakness, loss of appetite, and weight loss. Serum PTH increased. Xray of skeletal system shows generalized osteopenia with subperiosteal resorption of bone within the phalanges. MOA?
PTH mediated production of transforming growth factor beta 1?

Can someone explain the first question (Block 3 question 8) please? How can it be Peptic Ulcer disease if there are no ulcerations in the gastric mucosa? thanks.

 

BLOCK4

Granulation tissue is the correct answer (I got this right). After 1 week there will be granulation tissue as part of the wound repair (collagen type 3) that will be replaced later (after about a month) with type 1 collagen (scar tissue). I think they wanted to make sure we know the difference between granulation tissue (wound repair) and granuloma (containment of infection) .

 

BLOCK 4

Many people commented on this. Unfortunately I also got this answer wrong. My answer was Libido and nocturnal erections normal. It looks like decrease libido and normal nocturnal erections is also wrong (according to other people who marked this answer and got this wrong). I found this article on-line so it seems like the right answer is Decreased libido and nocturnal erections. The survey found that decreased libido was the major cause for absent of sexual intercourse: "A lack of sexual desire was the major cause of an absence of sexual intercourse."

https://www.ncbi.nlm.nih.gov/pubmed/18242374

 

conan said: ↑
Block 1 part 2

34) Skin from male mouse grafted on back of female. Within 2 wks graft becomes necrotic and must be removed. What cells responsible?
Netrophils?

38) Study conducted to determine effects of drug X on Airflow, Phrenic nerve activity and Abdominal. Tracing shown. Whats drug X?
Tubocurarine?

I got this question right and the correct answer is T lymphocytes. I double checked to make sure and this question does not appear as wrong in my report.

 

I was going to ask about this one...seems like acute rejection to me. I was between T and B lymphocytes because those are both involved in acute rejection as far as I understand. Can anyone explain why B lymphocytes is incorrect?

 

BLOCK 1

In this questions they give you a table disease and risk factor.
People with the disease:

• with risk factor: 50
• without risk factor: 50

People without the disease:

• with risk factor: 30
• without risk factor:70

To calculate Odd ratio - always start with people with the disease (the left column in the table given) and divide people with risk factor with people without risk factor: 50/50

Do the same in the right column (people without the disease) 30/70

Then divide the 2 values 50/50:30/70 = (50x70)/(50x30) = 2.3