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  #1  
Old 02-19-2012
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Arrow NBME 1 Block 4

Question 5:

I want to discuss something related to this question. I read somewhere (can't remember now) that Hep B can directly cause cancer without causing cirrhosis. While Hep C causes cancer due to cirrhosis (ie. due to constant cell turnover). I don't know if this is right or not, maybe one of you can shed light on this.

Is C the right answer by the way, I got confused because of that fact??


Question 12:

This one I think is D. Looks like fibrous tissue in the biopsy and all cell lines are decreased.


Question 15:

Don't think she would sue over poor communication because clearly the physician told her she is fine so the communication was not a problem.

I think the answer is A. If it does turn out to be cancer then she can sue on the basis that the physician failed to pick it up. But if its not cancer then obviously she won't sue him because she has no basis to sue him.

What do you guys think???


Question 36:

UNDERSTANDING of written and spoken speech would be Wernicke's area. So then wouldn't G be the right answer????


Question 46:

why A.....and why not D or even E

I picked D by the way. Less O2 in the air means lower PO2 but obviously the Hb will have normal saturation. But most importantly since PO2 is low, the arterial content will be low too. Fits the question.
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  #2  
Old 02-20-2012
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Question 5:

What i know is Hep B and both Hep C can cause cancer it can be only through a common pathway causing liver injury so both should cause cirrhosis.
For this Q its Hep C as it is the most common infection through blood transfusion

Q 12

In myelofibrosis there is extramedullary haematopoiesis so Hepatospleenomegaly is present. In myelofibrosis RBC Count is low but not as low as Aplastic anaemia.

Q 15

I had Marked B thinking the Pt. had undergone physician consultancy 2 months back may be the Physician saw some process which was although normal but may be was the beginning stage of some disease process and did not told the lady.

Q 36

I too choose G

Q 46
I too choose High altitude but now got it right.
See firstly High altitude would not have 98% saturation.
So Oxygen content = Hb *O2 saturation + O2 dissolved in plasma
so it can only occur if Hb is decreased that is Anaemia.

If you can help me with
Q2
wHATS THE ORGANISM in Q 16
Q 22
Q 38 if you can label all the part
Q 44
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  #3  
Old 02-20-2012
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Quote:
Originally Posted by jinni View Post
If you can help me with
Q2
wHATS THE ORGANISM in Q 16
Q 22
Q 38 if you can label all the part
Q 44
Q2:

That is a picture of a gap junction. Look up "freeze fracture images" on google and you will find websites with a lot of these pictures explaining in detail. As you know its for "Communication"


Q16:

S. Viridans/Mutans. Classic case of endocarditis after dental surgery.


Q22:

Basically here they are trying to see whether you know the routes of drugs, keeping in mind its for a systemic infection and oral.

Amphotericin is always given IV
Genta also believe is only given IV
Polymyxin is given topically
Vanco is only given orally for C. Difficile as it is not absorbed from gut. And C. Difficile is not a systemic infection.

Which only leaves Cipro which is a broad spectrum given for systemic diseases like Neisseria, Chlamydia, Osteomyelitis, Typhoid.


Q44:

Keeping in mind it is autosomal dominant so his son has 1/2 chance of getting it. Similarly if his son has it then his grandson also has 1/2 chance of getting it.

Therefore probability of his grandson getting it is = 1/2 X 1/2 = 0.25
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  #4  
Old 02-20-2012
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For Q 16
It says cloudy fluid and neutrophil in Pericardiocentesis. Does it not seem bacterial pericardial effusion so the bacteria here may be Pneumococcus.

http://en.wikipedia.org/wiki/Pericarditis

Q 44

I also took 1/2 chance of his grandchildren to be granddaughter.So for me it cam out to be 1/6.Am i wrong ??

What are the parts in Q 38?

Last edited by jinni; 02-20-2012 at 08:52 AM.
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  #5  
Old 02-20-2012
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Qs 5 . C is the right ans becoz Hep c most common in blood transfusion ...
and they started screening for it after 1985 . so thats another clue

Qs 12 . B . aplastic anemia ... adipose cells seen plus that appears to be a muscle type of artifect in it ....

Qs 15 ..... B ........ becoz he didnt tell her its a benign lesion and can be confused on mammography for CA ...... he just told her the results are normal ...so its poor communication

Qs 36 ...... even i felt its E ....... after seeing picture of wernickes from FA it appears E or G .... felt E was closer ..... the key is wrong here ..

Qs 46 is A .... anemia ...... as in high altitude Pao2 will be low and in diffusion defect both saturation cannot be 98%

Qs 2 . gap junction ...... all i found was that those thin lines where conexons .... for communication .....

Qs 16 ...... dental procedure its viridans..... and cloudy fluid is exudate with neutrophils definitely bacterial pericarditis ....

Qs 44 if it had been X linked then daughter and son ratio ... dont if this is correct but even if you took 1/6 the ans would be 16% which is not there , then you should select 1/4 ..... . i am bad at these .......

Qs 38 ...... are rough areas just to identify which fossa .....
still Y is around cribriform plate ...
X is inferior frontal
Z is brain stem ....

do tell me about 36 .ans is E or G ???
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  #6  
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hi
for Q 2 I choose A and I cant analyse the pic. ???still not understood why B??

Q 15 I chose A and he told her that everything is normal and that is enough for her to sue him for that base

Q17 isnt that supposed to be silent mutation and no effect as the difference in 3rd bp ???stii dont know why it is truncated protein??

Q25 why not A affinity , if there is isotype switching defect we would not find AB
Q 36 yes it is G and the key is wrong


Q37 how is that decrease C4 as in C1 esterase inhibitor def. that would activate C1 and iin turn increase C4 ??????????

Q50 does theophylline has diuretic action???
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how many Q u got wrong I had 12 , and really surprised , that is bad right??????
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  #8  
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Quote:
Originally Posted by Hitman View Post
Qs 44 if it had been X linked then daughter and son ratio ... dont if this is correct but even if you took 1/6 the ans would be 16% which is not there , then you should select 1/4 ..... . i am bad at these .......
Autosomal Dominant. Means that son has 50% chance of getting it, and if he has it then grandchild has 50% of getting it (regardless if they are male or female).

For probablity of grandson have to multiply the 2, chance of son and chance of grandson having it.

0.5 X 0.5 = 0.25


Quote:
Originally Posted by Hitman View Post
do tell me about 36 .ans is E or G ???
Well A as we know is Broca's area. Now Wernicke's area based on my opinion is G. I don't know what E is but it is far too posterior to be Wernicke's area. Wernicke's area is very close to Broca's right behind the sylvian fissure. I think G is the best location.
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  #9  
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Quote:
Originally Posted by rose View Post
hi
for Q 2 I choose A and I cant analyse the pic. ???still not understood why B??
It is a freeze fracture image. These are used for studying the components of the cell walls. Google it and you can read a little about it. Once you have gone through the various pictures you will see its the freeze fracture image of a gap junction.

Quote:
Originally Posted by rose View Post
Q 15 I chose A and he told her that everything is normal and that is enough for her to sue him for that base
I too thought it was A but then I thought about what Jinni said. The doctor could have noticed something but thought it wasn't dangerous so he didn't give her the complete picture. He could have told her that he saw something but doesn't think its a cause for concern. Now I think B is the best answer.

Quote:
Originally Posted by rose View Post
Q17 isnt that supposed to be silent mutation and no effect as the difference in 3rd bp ???stii dont know why it is truncated protein??
It is a frameshift mutation. When one base pair is added it shifts the reading frame. In FA if you look under the mutation section, it says a frameshift mutation causes truncation of the protein.

Quote:
Originally Posted by rose View Post
Q25 why not A affinity , if there is isotype switching defect we would not find AB
Basically here you have to know the difference between IgM and IgG. IgM can recognize the antigen and attach to it. It can also cause complement mediated lysis. Both are present in the scenario. But IgG is the one that opsonizes the antigen, IgM cannot do that. So basically the problem here is that he is creating IgM but then cannot class switch and produce IgG which is B, error in immunogloblin isotype switching. This is known as hyper IgM syndrome.

Quote:
Originally Posted by rose View Post
Q37 how is that decrease C4 as in C1 esterase inhibitor def. that would activate C1 and iin turn increase C4 ??????????
If you look at the classic pathway, normally C1 is broken down by C1 esterase and one of the products is C4. When C1 esterase is deficient, C4 is being consumed by unopposed C1 auto activation, there is no break in the pathway, goes all the way to C3a and then C5. So there will be decreased levels of both C1 and C4.

Quote:
Originally Posted by rose View Post
Q50 does theophylline has diuretic action???
For this you don't even know all the actions of theophylline. You can pick it just by eliminating all the other drugs based on them not fitting the description in the question.
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  #10  
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Quote:
Originally Posted by rose View Post
how many Q u got wrong I had 12 , and really surprised , that is bad right??????
Don't worry about how many you get wrong at this stage. You are still learning and focus on making sure you learn things which you didn't know.

As you can tell the questions are not hard, they are not testing any advanced concepts BUT you need to know the basics inside out. Slowly you will start realizing that even the ones you get wrong you knew the answer to but either you misread the question or didn't analyze it properly.

Keep doing questions. Not only will you solidify all your facts but you will also get better at figuring out what they are asking and how they are asking it. You will get better with more experience.
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Quote:
Originally Posted by haga View Post
Question 5:

I want to discuss something related to this question. I read somewhere (can't remember now) that Hep B can directly cause cancer without causing cirrhosis. While Hep C causes cancer due to cirrhosis (ie. due to constant cell turnover). I don't know if this is right or not, maybe one of you can shed light on this.

Is C the right answer by the way, I got confused because of that fact??


Question 12:

This one I think is D. Looks like fibrous tissue in the biopsy and all cell lines are decreased.


Question 15:

Don't think she would sue over poor communication because clearly the physician told her she is fine so the communication was not a problem.

I think the answer is A. If it does turn out to be cancer then she can sue on the basis that the physician failed to pick it up. But if its not cancer then obviously she won't sue him because she has no basis to sue him.

What do you guys think???


Question 36:

UNDERSTANDING of written and spoken speech would be Wernicke's area. So then wouldn't G be the right answer????


Question 46:

why A.....and why not D or even E

I picked D by the way. Less O2 in the air means lower PO2 but obviously the Hb will have normal saturation. But most importantly since PO2 is low, the arterial content will be low too. Fits the question.
Is this the offline one?
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  #12  
Old 02-20-2012
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yes.........
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Old 02-20-2012
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For Q 36 it is E see the wernicles area in following link
http://en.wikipedia.org/wiki/Wernicke's_area

Excellent explanation Haga and Hitman.

I think thats it for this block
moving now to next block.
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  #14  
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Hey rose you dont need to worry.............

As haga said just learn from the facts you got wrong.These NBME Q make you fine tune your preparation.
But then too i gave online NBME,they give you very slender chance of error you need to correct > 85 % correct to get a score 0f >230.I feel this is very tough task for me as i feel i am already saturated with my preparation. So just doing these offline Q so as i dont repeat the same errors while i do the real test.
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  #15  
Old 02-25-2012
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Quote:
Originally Posted by jinni View Post
As haga said just learn from the facts you got wrong.These NBME Q make you fine tune your preparation. So just doing these offline Q so as i dont repeat the same errors while i do the real test.
I just finished with this one.. At the beginning I though I was doing actually pretty good... then... when correcting the answers, I came to realize that I miss the questions on interpretation of the answer... and some of them because I didn't knew the answer. I scored really low. 84 bad answers... My exam is in april/27. I need to believe that I will do better next exam.
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