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  #1  
Old 09-27-2014
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Default NBME form 13 some clarifications

Hi, took my form 13 today..
Wanted clarifications on some of the questions. /thanks for the help in advance.

Section 1, Q20.

A previously healthy 54-year-old man comes to the clinic because of light-headedness for 6 hours. His symptom began after skiing at a resort at an altitude of 2743 m (9000 ft). He has been taking a carbonic anhydrase inhibitor since 2 days before arrival at the resort. His blood pressure is 110/60 mm Hg while sitting and 95/50 mm Hg while standing. Physical examination shows no other abnormalities. Which of the following is the most likely cause of his orthostatic hypotension?

A)High-altitude sickness

B)Hypovolemia

C)Hypoxia

D)Impaired sympathetic nerve activity

E)Respiratory alkalosis


Section 2, Q1
1.
A 39-year-old man comes to the physician because he has had an intense, stabbing pain behind his left eye for 5 nights. The headaches generally begin 1 hour after he goes to bed and last for about 1 hour. During the pain, he has left-sided nasal stuffiness and tearing from his left eye. He had a similar series of nightly headaches for 6 weeks several years ago. Which of the following is the most likely diagnosis?

A)Cluster headache

B)Factitious disorder

C)Generalized anxiety disorder

D)Sinusitis

E)Temporal arteritis

F)Tension-type headache

38.
Twenty subjects participate in a study of cardiopulmonary physiology. The pulmonary circulation of these subjects most likely has which of the following characteristics compared with their bronchial circulation?

A)Greater number of branches supplying the visceral pleura

B)Larger number of anastomoses with the intercostal arteries

C)Larger percentage of cardiac output

D)Larger volume of nutrient blood to the conducting airways

E)Lower-volume, higher-pressure system

Section 3
10.
A 9-year-old girl is brought to the emergency department by her father because of severe pain in her right shoulder after a fall 1 hour ago. Physical examination shows pain on movement of the right shoulder and a tender right clavicle. An x-ray of the shoulder shows a nondisplaced fracture of the right clavicle. Which of the following structures of the clavicle will most likely assist in producing new bone to heal this fracture?

A)Epiphysis

B)Haversian canal

C)Lamella

D)Periosteum

E)Volkmann canal



11.
A 54-year-old woman comes to the physician because of a 5-day history of severe mid-back pain. Physical examination shows point tenderness over the T6 vertebra. Serum studies show a calcium concentration of 13.4 mg/dL; urinalysis shows Bence Jones proteins. Which of the following is the most likely cause of this patient's hypercalcemia?

A)Excessive parathyroid hormone production

B)Excessive parathyroid hormone-related protein production

C)Increased fractional calcium gastrointestinal absorption

D)Local interleukin-1 (IL-1) and tumor necrosis factor effects

E)Unregulated 1,25-dihydroxycholecalciferol production


16.
A mouse melanoma, B-16, is highly metastatic. A clone of the B-16 melanoma cells is injected intravenously into the tail vein of mice, and 3 weeks later tumor nodules are found in the lungs, liver, and ovaries. When an antibody to a liver cell surface antigen is injected 1 hour prior to injection of the B-16 melanoma cells, formation of tumor nodules in the liver is prevented, but tumor nodules develop in the ovaries and lungs. In vitro studies do not show any cytotoxic effect of the antibody on B-16 or hepatic cells. Which of the following processes is most likely to be affected by the antibody?

A)Homing

B)Initiation

C)Invasion

D)Motility

E)Progression

F)Promotion
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  #2  
Old 09-27-2014
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Section 1, Q20 - Wasn't sure, took an educated guess, don't remember what I answered.

Section 2, Q1 - A) Cluster headache - clues are unilateral, retroorbital pain, with autonomic symptoms(nasal stuffiness, tearing of eye), coming in bouts with long periods of remission.

Q 38 - Was confused between A and C. I think i answered C - larger percentage of cardiac output. Just a guess.

Section 3, Q 10 - I answered D) Periosteum, because osteoblasts are present along the periosteum and cause new bone formation. But, I was confused about E) volkmann canal because it carries blood vessels which also would be important in healing.

Q11 - D) Local production of IL-1 and TNF. This lady has multiple myeloma. The tumor proliferation causes these cytokines to be released. They activate osteoclasts, leading to bone resorption and bone pain.

Q16 - A) Homing - It is postulated that when tumor cells metastasize they may be guided by release of cytokines or by presence of certain cell surface receptors, which explains why different tumors preferentially metastasize to certain organs. In this question, the antibody that was given blocked the cell surface receptors on liver cells preventing "homing" of tumor cells to the liver. Therefore, no liver metastases were found. But it still metastasized to ovary and lungs.


I am sorry to not be much help as I was myself confused on some of these questions when I took NBME 13. Hopefully, we'll both get the answers to the other questions on this forum
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Old 09-28-2014
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Q20 its hypovolemia...I guess due to use of diuretic
Q38 yea its C
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  #4  
Old 09-29-2014
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Thanks for the help. I was confused between hypovolemia and respiratory alkalosis.

Quote:
Originally Posted by excellence View Post
Q20 its hypovolemia...I guess due to use of diuretic
Q38 yea its C
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Old 09-29-2014
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On the contrary, You been of great help. I was confused similarly with Q38. It's hard to find the right answers. So thanks a lot!


Quote:
Originally Posted by shaarang_93 View Post
Section 1, Q20 - Wasn't sure, took an educated guess, don't remember what I answered.

Section 2, Q1 - A) Cluster headache - clues are unilateral, retroorbital pain, with autonomic symptoms(nasal stuffiness, tearing of eye), coming in bouts with long periods of remission.

Q 38 - Was confused between A and C. I think i answered C - larger percentage of cardiac output. Just a guess.

Section 3, Q 10 - I answered D) Periosteum, because osteoblasts are present along the periosteum and cause new bone formation. But, I was confused about E) volkmann canal because it carries blood vessels which also would be important in healing.

Q11 - D) Local production of IL-1 and TNF. This lady has multiple myeloma. The tumor proliferation causes these cytokines to be released. They activate osteoclasts, leading to bone resorption and bone pain.

Q16 - A) Homing - It is postulated that when tumor cells metastasize they may be guided by release of cytokines or by presence of certain cell surface receptors, which explains why different tumors preferentially metastasize to certain organs. In this question, the antibody that was given blocked the cell surface receptors on liver cells preventing "homing" of tumor cells to the liver. Therefore, no liver metastases were found. But it still metastasized to ovary and lungs.


I am sorry to not be much help as I was myself confused on some of these questions when I took NBME 13. Hopefully, we'll both get the answers to the other questions on this forum
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Old 09-29-2014
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Ok guys here are the answers!
20 A
1 A
38 C
10 A
11 D
16 A

So by picking A you get 4/6 correct!
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10 can't be A, Cuz that's the answer I marked, it was incorrect.

For the first one, he is on acetazolamide, he has been treated for high altitude sickness, so I don't know if that can be the answer.

Quote:
Originally Posted by nsesereso View Post
Ok guys here are the answers!
20 A
1 A
38 C
10 A
11 D
16 A

So by picking A you get 4/6 correct!
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Quote:
Originally Posted by meenaxi View Post
10 can't be A, Cuz that's the answer I marked, it was incorrect.

For the first one, he is on acetazolamide, he has been treated for high altitude sickness, so I don't know if that can be the answer.
Really. It was not last of my wrong questions too. And I think only that makes sense to me. Then I don't know.
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Old 09-29-2014
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10) D - It's Periosteum as periosteum contains progenitor cells which can eventually form osteoblasts.

20) Carbonic anhydrase inhibitors like acetazolamide don't just cause metabolic acidosis but also are diuretics --> hypovolemia
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Quote:
Originally Posted by qirkergaard View Post
20) Carbonic anhydrase inhibitors like acetazolamide don't just cause metabolic acidosis but also are diuretics --> hypovolemia
Diuretic effect of CAI is the weakest. It won't lead to as much hypovolemia as to cause postural hypotension.

Has anyone answered "D" and got wrong?

I think its D because met acidosis due to CAI --> respiratory compensation--> hyperventilation.

Which would lead to CO2 washout. Maybe that will cause cerebral vasoconstriction. which could lead to reduced perfusion of brain.
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Quote:
Originally Posted by DrNewB View Post
Diuretic effect of CAI is the weakest. It won't lead to as much hypovolemia as to cause postural hypotension.

Has anyone answered "D" and got wrong?

I think its D because met acidosis due to CAI --> respiratory compensation--> hyperventilation.

Which would lead to CO2 washout. Maybe that will cause cerebral vasoconstriction. which could lead to reduced perfusion of brain.
Ok. But what has that got to do with option D? D is "impaired sympathetic nerve activity"
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Quote:
Originally Posted by DrNewB View Post
Diuretic effect of CAI is the weakest. It won't lead to as much hypovolemia as to cause postural hypotension.

Has anyone answered "D" and got wrong?

I think its D because met acidosis due to CAI --> respiratory compensation--> hyperventilation.

Which would lead to CO2 washout. Maybe that will cause cerebral vasoconstriction. which could lead to reduced perfusion of brain.
http://books.google.co.in/books?id=a...ension&f=false

Check table 49-6
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  #13  
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Quote:
Originally Posted by qirkergaard View Post
Thanks friend.
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Quote:
Originally Posted by shaarang_93 View Post
Ok. But what has that got to do with option D? D is "impaired sympathetic nerve activity"
Sorry, I meant hypoxia. option "C". but after seeing Qirkergaard's post. I am convinced that its hypovolemia.
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you're welcome
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