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#1
02-23-2012
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NBME 1 Block 1 discussion

Q5:

I think its B. ATP depletion is the first thing that happens in ischemic cells, leading to decreased activity of the Na/K ATPase which caused cellular swelling.

Q29:

I think it's C. Key word here being activity. Renin will be more active on the right renal artery than the renal vein.

Q40:

I think it's A. If you plot a line that best fits the distribution it would be a line going through the middle (45 degree angle). This shows a linear relationship between the 2 and +1.00 is the best answer.

Q 45:

I think it's C. Case fatality rate would mean number of specific cases divided by total fatalities. There is 1 fatality from recreational. Total fatalities are 69...........So 1/69

#2
02-23-2012
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#5: i agree. less ATP -> decreased activity of Na/K-ATP-ase -> increased intracellular sodium -> water rushes in -> cell swelling.

#29: i agree. i also put C.

#40: answer key is correct. it's B. if it were A the dots would be closer together, hence signifying a very strong correlation. Here we see a loose correlation, hence the dots aren't so close together.

#45: answer key is correct. what you are explaining is total fatality rate, not case fatality rate. case fatality rate is number of deaths from that specific subcategory, therefore the denominator is 12, not 69.
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#3
02-23-2012
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Qs 5 ..... its a very tricky Qs .. its says mitochondrial swelling and glycogen loss ...... mitochondrial swelling implies irreversible injury .... so another irreversible injury is plasma membrane damage which is degradation of membrane phospholipid ...... so its C ..

Qs29 its D . what you are saying is actually AT 2 acting at right renal arteriole but renin made in JGA enters renal vein to enter blood circulation to form AT 2 ..... so it ratio of renin in right renal vein to left ......

Qs 40 ..from the diagram its clear thats its a postive co relation so now A and B are your choices . its pretty clear thay the dots are spread all over not is a single linear concentrated line so it B ...... you dont have to them and find a midline . they need to come very close and form a straight line to be 1+

Qs 45 yes case fatalities is deaths by all fatalities in the same group not the whole ...... here 1 dead in recreational activity out of 12 injuries in recreational so its 1/12 ...... infact i was wondering if we need to add 1 to 12 and select 1/13 ?? but since 12 is written in ALL recreational injuries it includes it

can you explain 26 and 43 ??

thanks
#4
02-23-2012
 USMLE Forums Master Steps History: 1+CK+CS Posts: 1,406 Threads: 118 Thanked 642 Times in 407 Posts Reputation: 652

Quote:
 Originally Posted by Hitman Qs 5 ..... its a very tricky Qs .. its says mitochondrial swelling and glycogen loss ...... mitochondrial swelling implies irreversible injury .... so another irreversible injury is plasma membrane damage which is degradation of membrane phospholipid ...... so its C .. Qs29 its D . what you are saying is actually AT 2 acting at right renal arteriole but renin made in JGA enters renal vein to enter blood circulation to form AT 2 ..... so it ratio of renin in right renal vein to left ...... Qs 40 ..from the diagram its clear thats its a postive co relation so now A and B are your choices . its pretty clear thay the dots are spread all over not is a single linear concentrated line so it B ...... you dont have to them and find a midline . they need to come very close and form a straight line to be 1+ Qs 45 yes case fatalities is deaths by all fatalities in the same group not the whole ...... here 1 dead in recreational activity out of 12 injuries in recreational so its 1/12 ...... infact i was wondering if we need to add 1 to 12 and select 1/13 ?? but since 12 is written in ALL recreational injuries it includes it can you explain 26 and 43 ?? thanks
#5: Dr. Sattar taught me (both in Kaplan and through pathoma) that cell swelling is the 1st sign of reversible cell change. irreversible cell change is characterized by cell wall damage.
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#5
02-23-2012
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Quote:
 Originally Posted by Hitman can you explain 26 and 43 ?? thanks
#6
02-23-2012
 USMLE Forums Master Steps History: 1+CK+CS Posts: 1,406 Threads: 118 Thanked 642 Times in 407 Posts Reputation: 652

Quote:
 Originally Posted by Hitman Qs 5 ..... its a very tricky Qs .. its says mitochondrial swelling and glycogen loss ...... mitochondrial swelling implies irreversible injury .... so another irreversible injury is plasma membrane damage which is degradation of membrane phospholipid ...... so its C .. Qs29 its D . what you are saying is actually AT 2 acting at right renal arteriole but renin made in JGA enters renal vein to enter blood circulation to form AT 2 ..... so it ratio of renin in right renal vein to left ...... Qs 40 ..from the diagram its clear thats its a postive co relation so now A and B are your choices . its pretty clear thay the dots are spread all over not is a single linear concentrated line so it B ...... you dont have to them and find a midline . they need to come very close and form a straight line to be 1+ Qs 45 yes case fatalities is deaths by all fatalities in the same group not the whole ...... here 1 dead in recreational activity out of 12 injuries in recreational so its 1/12 ...... infact i was wondering if we need to add 1 to 12 and select 1/13 ?? but since 12 is written in ALL recreational injuries it includes it can you explain 26 and 43 ?? thanks
26:
relative risk is:
(effected with stimulus/total effected) / (uneffected without stimulus/total uneffected)

as opposed to attributable risk which is the two brackets subtracted.

43: i fell ass backwards into this one, i just guessed and got it right. however haga's explanation of it was great.
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#7
02-23-2012
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Quote:
 Originally Posted by Dr.NickRiviera #5: Dr. Sattar taught me (both in Kaplan and through pathoma) that cell swelling is the 1st sign of reversible cell change. irreversible cell change is characterized by cell wall damage.
yes they are correct , but its mitochondrial swelling not cellular swelling they are different see pg no 221 in FA 2011 edition .. UW also say mitochondrial selling is a irreversible process due to increased permeability and release of cytochrome c....cell death .
#8
02-23-2012
 USMLE Forums Master Steps History: 1+CK+CS Posts: 1,406 Threads: 118 Thanked 642 Times in 407 Posts Reputation: 652

Quote:
 Originally Posted by Hitman yes they are correct , but its mitochondrial swelling not cellular swelling they are different see pg no 221 in FA 2011 edition .. UW also say mitochondrial selling is a irreversible process due to increased permeability and release of cytochrome c....cell death .
ok ill go check my FA
but before i do, does the glycogen depletion mean anything? does that mean glycogen has 'escaped' from the cell? which would occur with wall damage right? similar to how we measure troponin or CK-MB or amylase and lipase etc etc.
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#9
02-23-2012
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Quote:
 Originally Posted by Dr.NickRiviera ok ill go check my FA but before i do, does the glycogen depletion mean anything? does that mean glycogen has 'escaped' from the cell? which would occur with wall damage right? similar to how we measure troponin or CK-MB or amylase and lipase etc etc.
No its a simple glycogen loss , may be glycogen in the cell is used up in hypoxia ..... not found in blood .....

hey guys could we discuss all in any one of the threads , difficult to follow each other ........
#10
02-23-2012
 USMLE Forums Master Steps History: 1+CK+CS Posts: 1,406 Threads: 118 Thanked 642 Times in 407 Posts Reputation: 652

Quote:
 Originally Posted by Hitman yes they are correct , but its mitochondrial swelling not cellular swelling they are different see pg no 221 in FA 2011 edition .. UW also say mitochondrial selling is a irreversible process due to increased permeability and release of cytochrome c....cell death .
on that same page it has decreased glycogen as a characteristic of reversible change "-_-
confusion amplified.
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#11
02-23-2012
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also, the question is mitochondrial SWELLING, not PERMEABILITY.
so all signs seem to point to reversible change.
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#12
02-23-2012
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Quote:
 Originally Posted by Dr.NickRiviera also, the question is mitochondrial SWELLING, not PERMEABILITY. so all signs seem to point to reversible change.

well you would not have swelling without increase in permeability ..... UW also say mitochondrial vacuolization occurs in irreversible injury ..
#13
02-23-2012
 USMLE Forums Master Steps History: 1+CK+CS Posts: 1,406 Threads: 118 Thanked 642 Times in 407 Posts Reputation: 652

Quote:
 Originally Posted by Hitman well you would not have swelling without increase in permeability ..... UW also say mitochondrial vacuolization occurs in irreversible injury ..
im not so sure. the swelling results from water moving across the membrane. water is always free to move across the membrane, with the conc gradient being the only factor to affect osmosis.

also, decreased glycogen is a characteristic of reversible change as seen on that same page on FA (pg.221).
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#14
02-23-2012
 USMLE Forums Master Steps History: Not yet Posts: 928 Threads: 17 Thanked 538 Times in 375 Posts Reputation: 548

Quote:
 Originally Posted by Dr.NickRiviera im not so sure. the swelling results from water moving across the membrane. water is always free to move across the membrane, with the conc gradient being the only factor to affect osmosis. also, decreased glycogen is a characteristic of reversible change as seen on that same page on FA (pg.221).

I found this link .. it says its a irreversible injury ...

http://www.pathologyexpert.com/board...les/robby1.htm
#15
02-23-2012
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Quote:
 Originally Posted by Hitman I found this link .. it says its a irreversible injury ... http://www.pathologyexpert.com/board...les/robby1.htm
ok fair enough, irreversible it is.

also, i always had the mindset that angina = reversible injury to heart, MI = irreversible injury to heart. so since this person had an MI, it therefore is irreversible injury, as confirmed by the mitochondrial swelling.
is that logical?

although the decreased glycogen still stands as an indicator of reversible change and is a bit contradictory then innit
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#16
02-23-2012
 USMLE Forums Master Steps History: 1+CK+CS Posts: 1,406 Threads: 118 Thanked 642 Times in 407 Posts Reputation: 652

Quote:
 Originally Posted by Hitman I found this link .. it says its a irreversible injury ... http://www.pathologyexpert.com/board...les/robby1.htm
that link says "ATP depletion: ouabain-sensitive Na+,K+-ATPase in plasma membrane stops working, Na+ accumulates intracellularly, cell swells; cell switches to anaerobic metabolism (glycolysis) and glycogen stores are depleted, pH goes down."

we're overlooking glycogen mannnn
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#17
02-23-2012
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Quote:
 Originally Posted by Dr.NickRiviera ok fair enough, irreversible it is. also, i always had the mindset that angina = reversible injury to heart, MI = irreversible injury to heart. so since this person had an MI, it therefore is irreversible injury, as confirmed by the mitochondrial swelling. is that logical? although the decreased glycogen still stands as an indicator of reversible change and is a bit contradictory then innit

hey read this it will clear all your doubts ...... it seems the Qs is made word by word from it ....
http://www.ncbi.nlm.nih.gov/pubmed/1269093
#18
02-23-2012
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glycogen is an acute change (characteristic of reversible change)

but when we are looking at something that has undergone irreversible change, it displays chronic changes. and when something shows chronic change, it will also show the acute changes right?

so could we say here, the glycogen depletion is indicative of the initial phase of change but since we have mitochondrial swelling (and its an MI), we have extended beyond this acute change into chronic, irreversible change.
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#19
02-23-2012
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Quote:
 Originally Posted by Dr.NickRiviera glycogen is an acute change (characteristic of reversible change) but when we are looking at something that has undergone irreversible change, it displays chronic changes. and when something shows chronic change, it will also show the acute changes right? so could we say here, the glycogen depletion is indicative of the initial phase of change but since we have mitochondrial swelling (and its an MI), we have extended beyond this acute change into chronic, irreversible change.
yes that appears to be the case ......
#20
02-23-2012
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Quote:
 Originally Posted by Hitman yes that appears to be the case ......
awesome.

which block are we discussing tomorrow?
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#21
02-23-2012
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Quote:
 Originally Posted by Dr.NickRiviera awesome. which block are we discussing tomorrow?
starting with nbme 5 .....
#22
02-23-2012
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Quote:
 Originally Posted by Hitman starting with nbme 5 .....
ah, jumping from form1 to form5? lets do form 2 next!

did you guys discuss block4 up in here? it didnt show up when i searched "nbme form 1 discussion".
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#23
02-23-2012
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Quote:
 Originally Posted by Dr.NickRiviera ah, jumping from form1 to form5? lets do form 2 next! did you guys discuss block4 up in here? it didnt show up when i searched "nbme form 1 discussion".
we are done with NBME 2 and this was the last block of NBME 1 that was left we went from block 4 to 1 in NBME 1 ......
#24
02-23-2012
 USMLE Forums Master Steps History: 1+CK+CS Posts: 1,406 Threads: 118 Thanked 642 Times in 407 Posts Reputation: 652

Quote:
 Originally Posted by Hitman we are done with NBME 2 and this was the last block of NBME 1 that was left we went from block 4 to 1 in NBME 1 ......
this offline forms are the same as online right?
i don't want to do the questions and then see them again when i do the online nbmes
although, ive already done nbme form 5 online
so the offline will be the exact same as that?
could this questions show up in another online form?
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#25
02-23-2012
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Quote:
 Originally Posted by Dr.NickRiviera this offline forms are the same as online right? i don't want to do the questions and then see them again when i do the online nbmes although, ive already done nbme form 5 online so the offline will be the exact same as that? could this questions show up in another online form?
the offline nbme 5 is exactly the same as online nbme 5 ..... just the Qs may be jumbled from one block to another ......

but if you solve from the offline ones , we all will have the same Qs with same nos ,so no problem in discussing it with numbers .......

#26
02-23-2012
 USMLE Forums Master Steps History: 1+CK+CS Posts: 1,406 Threads: 118 Thanked 642 Times in 407 Posts Reputation: 652

Quote:
 Originally Posted by Hitman the offline nbme 5 is exactly the same as online nbme 5 ..... just the Qs may be jumbled from one block to another ...... but if you solve from the offline ones , we all will have the same Qs with same nos ,so no problem in discussing it with numbers .......
so offline nbme 5 questions will only show up on online nbme form 5, not on online nbme form 7,11,12?
if thats the case, then im down to do 5 seeing as i wont be doing online form 5 again and therefore wont see these offline questions again.
right?
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#27
02-23-2012
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Quote:
 Originally Posted by Dr.NickRiviera so offline nbme 5 questions will only show up on online nbme form 5, not on online nbme form 7,11,12? if thats the case, then im down to do 5 seeing as i wont be doing online form 5 again and therefore wont see these offline questions again. right?
yes , the offline and online nbme 5 Qs are the same you wont see them in your online 11, 7, 12 ....

since you have done 5 , have a look at the offline 5 .. you will find they the same ..........
#28
02-23-2012
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Quote:
 Originally Posted by Hitman yes , the offline and online nbme 5 Qs are the same you wont see them in your online 11, 7, 12 .... since you have done 5 , have a look at the offline 5 .. you will find they the same ..........
ok cool, which block we discussing first?
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#29
02-23-2012
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Quote:
 Originally Posted by Dr.NickRiviera ok cool, which block we discussing first?
mostly block 1 ..... if any changes will PM you ...
#30
02-23-2012
 USMLE Forums Master Steps History: 1+CK+CS Posts: 1,406 Threads: 118 Thanked 642 Times in 407 Posts Reputation: 652

Quote:
 Originally Posted by Hitman mostly block 1 ..... if any changes will PM you ...
alright cool.
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#31
02-23-2012
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Hey guys i will like to join u in doing this nbme form..PM me what block and which nbme are u ppl doing if u dont mind
#32
02-23-2012
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Quote:
 Originally Posted by mohitkmc Hey guys i will like to join u in doing this nbme form..PM me what block and which nbme are u ppl doing if u dont mind
sure , most welcome ......
#33
02-23-2012
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WOw , u seem to start very early
can any one explain to me
Q 19 since BP is increased and rennin is decraesed why s.k+ is decreased ?? and urnary K+ is inreased , it should be the opposite since aldosterone secretion is decreased??

ALso Q 27????
#34
02-23-2012
 USMLE Forums Master Steps History: Not yet Posts: 928 Threads: 17 Thanked 538 Times in 375 Posts Reputation: 548

Quote:
 Originally Posted by rose WOw , u seem to start very early can any one explain to me Q 19 since BP is increased and rennin is decraesed why s.k+ is decreased ?? and urnary K+ is inreased , it should be the opposite since aldosterone secretion is decreased?? ALso Q 27????
Fludrocortisone acts on mineralocorticoid receptors also to it acts as aldosterone ....... thus it decrease K+ in serum , increase K+ in urine and decreases renin by negative feedback ...

Qs 27 leukoplakia is a predisposing factor for SCC .. so it has gradually progressed to SCC .....

 Tags NBME-

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