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  #1  
Old 02-24-2012
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Arrow NBME 5 Block 1 discussion

Q2:

I think it is B. The time till onset of symptoms (18 hours) is way too long for it to be epidural. Subdural makes more sense, slow bleeding from veins.


Q14:

I know it's the pre-motor cortex but its so hard to tell which one it is on the internal view. Can you please tell me all the parts???


Q33:

I think it is E. Warm water quick phase is to same side. Cold water quick phase is to opposite side. COWS.
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  #2  
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Its E only. My answer key gives it E.


Q4. Why it cant be D. Lactic acid???In hypoxia it will also increase

Q18. Can someone explain why its E.

Q20.Why not D. both flexor pollicis longus and extensor pollicis longus are inserted on Distal phalynx


Also can some one explain me answer for 41 and 45...
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  #3  
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Ok HUGA: 2ND Q its D. only the given case is of epidural hematoma as they mention that he was normal after injury and symptoms occured after 18 hr so LUCID interval.
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#2: i agree. i also put B.

#14: i suck at neuro, i had guessed B because i figured it would be somewhere in frontal cortex. would love to hear an explanation on this question.

#33: no movement of eyes on right side. so the left side is messed up right? i had guessed E, but then again i suck at neuro.
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Quote:
Originally Posted by mohitkmc View Post
Its E only.My answer key gives it E.


Q4. Why it cant be D. Lactic acid???In hypoxia it will also increase

Q18. Can someone explain why its E.

Q20.Why not D. both flexor pollicis longus and extensor pollicis longus are inserted on Distal phalynx


Also can some one explain me answer for 41 and 45...
#41: A is the only one that made sense to me. what did you think it was?

#45: thats a classic set up for a crossover experiment. you give each group their own drug, then u switch the drugs. this way u are not preventing anybody from getting the useful drug (you cant give one group the drug that works and one group a placebo, placebo group will die lol). It's in kaplan, last page of whatever chapter talks about the studies.
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  #6  
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#7: where is this written? is it in FA or kaplan anywhere? i had NO CLUE here.

#9: ALS is upper and lower motoneuron defects right? so in this question the dorsal coloum is lower and the ventral roots are upper? is that how you determine the answer is ALS?

#11: explanation please.

#18: explanation please.

#20: explanation please.

#21: why not A? don't you need CD4+ T cells to cause class switching and production of antibodies?

#26: explanation please.

#31: answer key is wrong. answer is A.

#33: explanation please. i put F.

#40: explanation please.

Man, this whole block was neuro!! what a tough block.
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Quote:
Originally Posted by mohitkmc View Post
Ok HUGA: 2ND Q its D. only the given case is of epidural hematoma as they mention that he was normal after injury and symptoms occured after 18 hr so LUCID interval.
So in epidural it is rupture of the middle meningeal. This is an arterial bleed so it is under great pressure and there is rapid expansion.

According to Wiki:

"These patients have a history of head trauma with loss of consciousness, then a lucid period, followed by loss of consciousness. Clinical onset occurs over minutes to hours."


I don't think it can be epidural based on that. I think the 18 hours should be viewed as a symptom of a subdural hemorrhage. Slow venous bleeding, less pressure so hematoma develops over time with delayed onset of symptoms (taken from FA).
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  #8  
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Quote:
Originally Posted by mohitkmc View Post
Q4. Why it cant be D. Lactic acid???In hypoxia it will also increase
You have to realize that RBCs only perform anaerobic metabolism, they don't have mitochondria. So doesn't matter what the situation, normal or hypoxic, RBCs will always produce lactate. This is also part of the Cori cycle where the lactate produced in the RBCs is taken to the liver and turned back into glucose.

Here's the important part. In hypoxic conditions there is an increase production of 2,3-BPG. This facilitates greater unloading of O2 at the tissues ESPECIALLY in cases where a person cannot maintain adequate tissue oxygenation. It causes the O2-disassociation curve to shift right.


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Originally Posted by mohitkmc View Post
Q18. Can someone explain why its E.
The right answer is A. Basically the principle behind this is that when you give a Marrow transplant to someone they don't have their own immunologic response. The Graft bone marrow takes over production of all immunologic cells....and hence one of the advantages of this is that the host's body cannot reject this graft.


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Q20.Why not D. both flexor pollicis longus and extensor pollicis longus are inserted on Distal phalynx
The X-Ray clearly shows that the anterior aspect of the carpal bone is affected. Flexor is attached towards the anterior aspect and Extensor is attached towards the posterior surface.


Quote:
Originally Posted by mohitkmc View Post
Also can some one explain me answer for 41 and 45...
41. Basically they are testing if you know the lymphatic drainage of the lower limb. The wound on his foot is infected and the lymph from the lower limb eventually drains into the inguinal lymph nodes. In cases of infection, usually there is painful lymphadenopathy in the draining region.

45. As Dr. Nick explained, it is a crossover study where both groups get both treatments.
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  #9  
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Quote:
Originally Posted by Dr.NickRiviera View Post
#33: no movement of eyes on right side. so the left side is messed up right? i had guessed E, but then again i suck at neuro.
Its in FA under the vestibular apparatus section.

When you put Cold Water in an ear the nystagmus is towards the lesion with quick phase to the opposite side.

When you Put Warm Water in an ear the nystagmus is to the opposite side with quick phase to the same side.

remember the mnemonic COWS. Cold opposite, Warm Same


So since they used warm water and the quick phase was to the left, then the lesion was on the Left side.
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Originally Posted by Dr.NickRiviera View Post
#7: where is this written? is it in FA or kaplan anywhere? i had NO CLUE here.
Don't know about Kaplan and its not written in FA. I think I picked it up from High Yield NeuroAnatomy. Basically the way I put it together is that there are 2 excitatory neurotransmitters. Glutamate and Aspartate. Since these are excitatory, any one of these can cause increased entry of positive ions into cells.


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Originally Posted by Dr.NickRiviera View Post
#9: ALS is upper and lower motoneuron defects right? so in this question the dorsal coloum is lower and the ventral roots are upper? is that how you determine the answer is ALS?
Well in the stem they tell you that BOTH the ventral roots and corticospinal tracts are knocked off. If you look at the picture of ALS under the spinal cord lesions in FA, you'll see that the same areas are grayed out.

Classic ALS, only disease that knocks off ONLY both of these. Anterior Spinal Artery occlusion will also knock off both of these but it will also affect other areas too. ALS, just these 2.


Quote:
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#11: explanation please.
Alzheimers dementia. Widespread cortical atrophy. B is the only answer that fits this.


Quote:
Originally Posted by Dr.NickRiviera View Post
#18: explanation please.
Answered in previous post.


Quote:
Originally Posted by Dr.NickRiviera View Post
#20: explanation please.
Answered in previous post.


Quote:
Originally Posted by Dr.NickRiviera View Post
#21: why not A? don't you need CD4+ T cells to cause class switching and production of antibodies?
In HIV the main cause for concern is just CD4+. Now you're right you still need CD4+ to class switch to IgG, but that doesn't mean you can't produce IgM. Since this is still made there is some antibody directed cytotoxicity. In fact in full blown AIDS there are no CD4+ cells to produce IgG, IgA or IgE but production of IgM is still possible without T cell help. Total immunoglobulins are even seen to be greatly increased as B cells are stuck making IgM in huge amounts.

The main thing to know here is IL-2 which is MANDATORY for CD4+ cell production.


Quote:
Originally Posted by Dr.NickRiviera View Post
#26: explanation please.
That is the location of the pineal gland (resp. for melatonin production). Since they say it's an expanding lesion you can deduce it's a pineal gland adenoma. This causes 2 problems.

1. Paralysis of the upward gaze centre (Parinaud syndrome)
2. Compression of aquesuct of sylvius leading to obstructive hydrocephalus.


Quote:
Originally Posted by Dr.NickRiviera View Post
#31: answer key is wrong. answer is A.
Blood group O has anti A, Anti B and Anti AB antibodies. When given type A blood, the Anti A antibodies will attach to the Type A RBCs. This causes a type 2 hypersensitivity reaction leading to lysis by complement. Remember type 2 hypersensitivity is mainly cytotoxic. Antibody and complement lead to membrane attack complex.


Quote:
Originally Posted by Dr.NickRiviera View Post
#33: explanation please. i put F.
Explained in previous post.


Quote:
Originally Posted by Dr.NickRiviera View Post
#40: explanation please.
Look at the complement pathway in FA.

C3a and C5a are the anaphylatoxins. First they are activated and then they lead to further activation of the membrane attack complex (C5b-C9). Since only C6 is deficient, everything before it will be normal and everything past it will be abnormal.

Since C3a and C5a are still present there will still be anaphylatoxins. But since C6 is missing there will be no formation of the membrane attack complex and bacterial killing will not happen.


Quote:
Originally Posted by Dr.NickRiviera View Post
Man, this whole block was neuro!! what a tough block.
Tell me about it!!!! Even though I managed to answer most of the questions it took me way too long to finish the block. If the real exam is anything like this...I'm screwed.
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  #11  
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Qs 2 is subdural hematoma ... the ans is B ........ no loss of consciousness , its not a lucid interval , its slow bleeding ......

Qs 7 see FA pg 436 .... its glutamate .

Qs 9 .. its ALS becoz corticospinal tract damage is umn and ventral horn is LMN , its corticospinal not dorsal column .. ALS has no sensory loss

Qs 11 .its alzheimers . so degeneration of cortical neurons ..

Qs 14 .. A is Inferior frontal cortex , B is premotor cortex ,C is paracentral lobule, D is postcentral somatosensory cortex , E is sensory cortex

so premotor cortex appears to control the movements ..

Qs 18 ... GVHD the T lymphocytes will kill the leukemic cell , thus GVHD turns out to be helpful ..

Qs 20 Flexor pollicis because lesion is on the anterior side where it attaches to flex the thumb

Qs 21 well CD4 cells need IL 2 for replication , In HIV cell mediated immunity is the major loss not antibody production which is normal and detected on ELISA .... thus IL2 fits the best

Qs 26 is PArinauds syndrome ..... leading to vertical gaze palsy a pineal gland location is shown .. which would compress superior colliculus to cause vertical gaze palsy ..

Qs 31 . HAve a doubt in this felt its B , but many say A

Qs 33 is F no response when warm water put into right ear , right vestibular lesion ...

Qs 40 ... decrease bacterial killing is easy , but anaphylatoxins that are C3a , C5a are normal as the Qs says only C6 is affected ...

Qs 41 A is the ans a lymphnode cell proliferate in response to inflammation .. as it drains the foot ..

Qs 45 its a cross over study , its given in FA pg 53 right side 3rd point ...

could any one explain 31 and 39 (label other parts ) ??
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  #12  
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guys i think my answer key has lot of wrong answers
Can someone pls send me there anser key thats the reason i asked 41 and 45 my answer key gives as 41. E and 45.F and in no way i thought it can be them thats why asked it
Please someone send me the answer key
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Quote:
Originally Posted by haga View Post
Q2:

I think it is B. The time till onset of symptoms (18 hours) is way too long for it to be epidural. Subdural makes more sense, slow bleeding from veins.


Q14:

I know it's the pre-motor cortex but its so hard to tell which one it is on the internal view. Can you please tell me all the parts???


Q33:

I think it is E. Warm water quick phase is to same side. Cold water quick phase is to opposite side. COWS.
Q2
Yes you are right its B epidural has loss of conciousness and lucid interval.

Q 14
I marked it E thinking of apraxia due to lesion in Posterior parietal association cortex.But then Prmotor cortex lesion too produces the same lesion.
B- Premotor cortex
C- Primary motor cortex
D- Primary sensory cortex
E - Posterios parietal association area.
I am confused but what do you think

Q16
yes you are right but the direction of nystagmus is opposite to the side of lesion in case of lesion in vestibular apparatus.
I do this in a simple way when we instill hot water the same ear semicircular canal is stimulated so the eye looks the opposite side and the fast phase is towards the site where we instilled hot water.Whereas if we cold water that side if the vestibular apparatus gets lesioned so what happens in there is unopposed action of the other Vetibular apparatus rest of the story you can understand..........
Here warm water addition did not get any respond so most probably it is lesioned
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  #14  
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35. ITS D in hypertrophy there is increase in lengh of the muscle fibre no increase in number and due to increase muscle activity it will increase number of mitochondria btother 2 parameters do not change in numbr
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Can you please help me with following qns.

3. please label F and G for me

10.No idea

11. I know B is correct but was confused with D too isnt there decreased acetylcholine in Alzheimers disease so was thinking this can be the answer too

31 I think A is the answer

36 no idea pls explain

35 what is the effect on actin should it remain constant ??

Last edited by jinni; 02-24-2012 at 11:11 AM.
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Quote:
Originally Posted by Hitman View Post
Qs 31 . HAve a doubt in this felt its B , but many say A
I agree. In FA it says that in type 2 hypersensitivity (which this is) the main mechanism of killing is through membrane attack complex. Now you also have to understand what happens in blood mismatches, there is massive intravascular hemolysis which would only be caused by complement lysis.


Quote:
Originally Posted by Hitman View Post
Qs 33 is F no response when warm water put into right ear , right vestibular lesion ...
Oh Boy I didn't even read the part about the right ear. Yes so the test in the Left ear is normal then. Warm water causes opposite nystagmus with quick phase to same side (normal response to warm water) and since Right side response is absent then the lesion must be there.


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Originally Posted by Hitman View Post
39 (label other parts ) ??
A. Subthalamic N.
B. Hippocampus
C. Substantia Nigra
E. Thalamus

D. No clue?????
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Quote:
Originally Posted by jinni View Post
Q 14
I marked it E thinking of apraxia due to lesion in Posterior parietal association cortex.But then Prmotor cortex lesion too produces the same lesion.
B- Premotor cortex
C- Primary motor cortex
D- Primary sensory cortex
E - Posterios parietal association area.
I am confused but what do you think
It is definitely premotor cortex!! It is the area that does the planning.


Quote:
Originally Posted by jinni View Post
Q16
yes you are right but the direction of nystagmus is opposite to the side of lesion in case of lesion in vestibular apparatus.
I do this in a simple way when we instill hot water the same ear semicircular canal is stimulated so the eye looks the opposite side and the fast phase is towards the site where we instilled hot water.Whereas if we cold water that side if the vestibular apparatus gets lesioned so what happens in there is unopposed action of the other Vetibular apparatus rest of the story you can understand..........
Here warm water addition did not get any respond so most probably it is lesioned
ok so this is where I'm confused. The response in the Left ear is normal, that is what should happen when you put Warm water. But there is no response in the right ear at all. So then shouldn't the problem be in the Right ear as there is no response at all???
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Quote:
Originally Posted by haga View Post
I agree. In FA it says that in type 2 hypersensitivity (which this is) the main mechanism of killing is through membrane attack complex. Now you also have to understand what happens in blood mismatches, there is massive intravascular hemolysis which would only be caused by complement lysis.




A. Subthalamic N.
B. Hippocampus
C. Substantia Nigra
E. Thalamus

D. No clue?????
D is insula
Q 31
So B is correct right?
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Quote:
Originally Posted by jinni View Post
Can you please help me with following qns.

3. please label F and G for me

10.No idea

11. I know B is correct but was confused with D too isnt there decreased acetylcholine in Alzheimers disease so was thinking this can be the answer too

31 I think A is the answer

36 no idea pls explain

35 what is the effect on actin should it remain constant ??
3. F-CN 12 AND G-9 OR 10 nt sure because he is marking both the nerves

10.I think its E. Narcolepsy its given in FA pg no 63..
31. I agree with u on A
36. Stenosis of Aq of sylvius is the most common cause of cong. hydrocephalus its present just after lateral ventricle hence only lateral ventricle enlargement no effect on 3rd or 4th ventricle

35. D there is no change in number of actin inhypertrophy
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Quote:
Originally Posted by mohitkmc View Post
35. ITS D in hypertrophy there is increase in lengh of the muscle fibre no increase in number and due to increase muscle activity it will increase number of mitochondria btother 2 parameters do not change in numbr

Qs 35 is B . the number of actin increases ....

Satellite cells function to facilitate growth, maintenance and repair of damaged skeletal (not cardiac) muscle tissue . These cells are termed satellite cells because they are located on the outer surface of the muscle fiber, in between the sarcolemma and basal lamina (uppermost layer of the basement membrane) of the muscle fiber. Satellite cells have one nucleus, with constitutes most of the cell volume.
Usually these cells are dormant, but they become activated when the muscle fiber receives any form of trauma, damage or injury, such as from resistance training overload. The satellite cells then proliferate or multiply, and the daughter cells are drawn to the damaged muscle site. They then fuse to the existing muscle fiber, donating their nuclei to the fiber, which helps to regenerate the muscle fiber. It is important to emphasize the point that this process is not creating more skeletal muscle fibers (in humans), but increasing the size and number of contractile proteins (actin and myosin) within the muscle fiber

http://www.unm.edu/~lkravitz/Article...pertrophy.html
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Quote:
Originally Posted by haga View Post
It is definitely premotor cortex!! It is the area that does the planning.




ok so this is where I'm confused. The response in the Left ear is normal, that is what should happen when you put Warm water. But there is no response in the right ear at all. So then shouldn't the problem be in the Right ear as there is no response at all???
From right ear impulse travel from semicircular canal to vestibular apparatus then to brain so lesion will be between scc and vestibular apparatus
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Quote:
Originally Posted by jinni View Post
Can you please help me with following qns.

3. please label F and G for me
Same diagram as in FA.

F: CN X11 (remember looks like it has multiple roots)

G: With this one I feel they are labelling 2 nerves together. CN IX and CN X. That is their normal location


Quote:
Originally Posted by jinni View Post
10.No idea
Classic description of Narcolepsy. Basically it is REM run wild, good way to remember it.

1. Sleep attacks / excessive daytime sleepiness.
2. Cataplexy: loss of all muscle tone following strong emotional stimulus, in this case laughing.
3. Vivid dreams/nghtmares: a good description of hallucinations (could be either hypnagogic or nypnopompic. His dreams feel real.
4. Spends long hours sleeping


Quote:
Originally Posted by jinni View Post
11. I know B is correct but was confused with D too isnt there decreased acetylcholine in Alzheimers disease so was thinking this can be the answer too
There is decreased acetylcholine in the brain due to decreased production. Cerebral atrophy also effects site of Ach production, basal nucleus of meynart. Will not be due to increased ACHesterase.


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Originally Posted by jinni View Post
31 I think A is the answer
Blood group O has anti A, Anti B and Anti AB antibodies. When given type A blood, the Anti A antibodies will attach to the Type A RBCs. This causes a type 2 hypersensitivity reaction leading to lysis by complement. Remember type 2 hypersensitivity is mainly cytotoxic. Antibody and complement lead to membrane attack complex.

In FA it says that in type 2 hypersensitivity (which this is) the main mechanism of killing is through membrane attack complex. Now you also have to understand what happens in blood mismatches, there is massive intravascular hemolysis which would only be caused by complement lysis.


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36 no idea pls explain
He has hydrocephalus. Basically you have to know the most common causes. The Most Common Cause of hydrocephalus in a newborn is stenosis of the aqueduct of sylvius and the sutures have not fused. Straight from the mouth of Goljan in his audio lectures.
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[QUOTE=jinni;96660]Can you please help me with following qns.

11. I know B is correct but was confused with D too isnt there decreased acetylcholine in Alzheimers disease so was thinking this can be the answer too


even if its D you cannot see it on the autopsy ......
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hey could you explain 46 ???
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huga:for Q 3 check pg no. 415 FA the one with multiple branch is CN 12 and the 11 is the one which go all along the spinal cord which in this diagram is not labelled bt u cn see it running along the side
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Old 02-24-2012
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Quote:
Originally Posted by mohitkmc View Post
huga:for Q 3 check pg no. 415 FA the one with multiple branch is CN 12 and the 11 is the one which go all along the spinal cord which in this diagram is not labelled bt u cn see it running along the side
Ya it is 12...I just wrote it X11....so it looks like 11 but its supposed to be 12.
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Old 02-24-2012
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For 31st question answer is B
RBC coated by C3B alone are phagocytosed by liver macrophage-EXTRAVASCULAR HEMOLYSIS
RBC coateed by C5-9-INTRAVASCULAR HEMOLYSIS
RBC coated by IG G and C3B phagocytosed by liver and spleen macrophages(eg SLE)-EXTRAVASCULAR HEMOLYSIS
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  #28  
Old 02-24-2012
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Quote:
Originally Posted by Hitman View Post
hey could you explain 46 ???
Leprosy. Nose and eye lesions and hilar lymphadenopathy. It is not as pronounced so it should be Tuberculoid Leprosy which is limited to a few hypoesthetic nodules mainly because cellular immunity is intact.

And you know with TB or Leprosy the way the body reacts is through granulomatous inflammation with giant cells.
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  #29  
Old 02-24-2012
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Quote:
Originally Posted by haga View Post
Leprosy. Nose and eye lesions and hilar lymphadenopathy. It is not as pronounced so it should be Tuberculoid Leprosy which is limited to a few hypoesthetic nodules mainly because cellular immunity is intact.

And you know with TB or Leprosy the way the body reacts is through granulomatous inflammation with giant cells.
Its not leprosy its SARCOIDOSIS
characterstic-foreign body like granuloma formation plus bilateral hilar lumphadenopathy
The skin lesion are also characterstic involving nose commonly called lupus pernio
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Quote:
Originally Posted by mohitkmc View Post
Its not leprosy its SARCOIDOSIS
characterstic-foreign body like granuloma formation plus bilateral hilar lumphadenopathy
The skin lesion are also characterstic involving nose commonly called lupus pernio
You're RIGHT!!!!

my bad. I got the answer right, same mechanism I think so I thought that was the right answer. I hope I make mistakes like this in the exam as well....
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  #31  
Old 02-24-2012
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guys, #31 is is A. u have to cleave C3 to even get to the membrane attack complex!

and for the nystagmus one, are we saying Left or Right vestibular nuclei?
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  #32  
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Quote:
Originally Posted by mohitkmc View Post
Its not leprosy its SARCOIDOSIS
characterstic-foreign body like granuloma formation plus bilateral hilar lumphadenopathy
The skin lesion are also characterstic involving nose commonly called lupus pernio
messed up nose and eyes is sarcoidosis?
ive gotten this pic (of a bubbly nose and eyelids) twice now and i have no idea what the diagnosis is!
help!
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Quote:
Originally Posted by Dr.NickRiviera View Post
guys, #31 is is A. u have to cleave C3 to even get to the membrane attack complex!

and for the nystagmus one, are we saying Left or Right vestibular nuclei?
Normal response in Left with warm water. No response in Right, so problem in Right.


Ok there are 2 types of C3....C3a and C3b......

in the classic pathway (antigen-antibody, same as this): C3a is the product. This will cause anaphylaxis and then production of the membrane attack complex.

Now in the alternative pathway (microbial surface antigen) there is production of C3b which opsonizes bacteria for phagocytosis and also clears the immune complexes from the serum.

Here's a pearl from Goljan.

Intravascular hemolysis (this case): C5-C9 mediated
Extravascular hemolysis: IgG or C3b mediated (as explained above)

IgM mediated can cause either intravascular or extravascular hemolysis.
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Quote:
Originally Posted by Dr.NickRiviera View Post
messed up nose and eyes is sarcoidosis?
ive gotten this pic (of a bubbly nose and eyelids) twice now and i have no idea what the diagnosis is!
help!
Well you can't go based solely on the picture. You have to correlate the stem with the picture.

In this case the stem only said Hilar Lymphadenopathy. Then in the picture its a black female and has what looks like epithelial granulomas on her nose and eyes.

3 things right there pathognomonic of Sarcoidosis.

1. Hilar Lymphadenopathy
2. Black female
3. Epithelial granulomas

I don't think there's many diseases that can present like this. Myself, I thought it was Leprosy because I didn't even remember what Sarcoidosis presented as. Now that I went over it again, it can't be anything else in this case.

I'm not sure about how the picture or stem was in the other question you had.
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Can anybody post a link where i can find the answers for NBME5?
Thanks!
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Quote:
Originally Posted by mohitkmc View Post
Ok HUGA: 2ND Q its D. only the given case is of epidural hematoma as they mention that he was normal after injury and symptoms occured after 18 hr so LUCID interval.
yup, it's D d/t lucid interval..
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No 2 ...
Very stupid question. I chose D epidural but then could be subdural too! The patient hit the back of her head so i think epidural would be less likely?? because epidural is more common with lateral blows! Plus, they did not mention any kind of temporary loss of consciousness which should have preceeded the lucid interval. So now i think it IS SUBDURAL

No 3 .. are these labellings fine?? confusing!
A.oculomotor
B.trigeminal
C.abdecens
D.facial
E.vestibulosochlear
F.hypoglossal
G. glossopharyngeal??? i dont know~!

No 20
I have no idea how you guys know that this is the anterior aspect they are showing! i suck at x rays. someone please explain

No 35
I think itss B. with hypertrohpy, doesnt the number of actin filaments also increase?????

No 41
My answer key says its E??????????????????????
I strongly think its A,cellular proliferation in inguinla nodes! as some of you have mentioned above too!

No 44
can someone explain the picture?? i guessed it must kaposi sarcoma but i have no idea what the picture is showing~
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Quote:
Originally Posted by numbndumb View Post
No 2 ...
Very stupid question. I chose D epidural but then could be subdural too! The patient hit the back of her head so i think epidural would be less likely?? because epidural is more common with lateral blows! Plus, they did not mention any kind of temporary loss of consciousness which should have preceeded the lucid interval. So now i think it IS SUBDURAL

No 3 .. are these labellings fine?? confusing!
A.oculomotor
B.trigeminal
C.abdecens
D.facial
E.vestibulosochlear
F.hypoglossal
G. glossopharyngeal??? i dont know~!

No 20
I have no idea how you guys know that this is the anterior aspect they are showing! i suck at x rays. someone please explain

No 35
I think itss B. with hypertrohpy, doesnt the number of actin filaments also increase?????

No 41
My answer key says its E??????????????????????
I strongly think its A,cellular proliferation in inguinla nodes! as some of you have mentioned above too!

No 44
can someone explain the picture?? i guessed it must kaposi sarcoma but i have no idea what the picture is showing~
2- the long time for the symptoms to appear points to subdural... becoz its a venous ooze it can take longer time to develop, while epidural is an arterial bleed.. wud present more quickly and yes with a lucid interval (atleast on our exam)

35- yup, actin has to increase... the eccentric hypertrophy and concentric hypertrophy ...

41- A is correct...
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Old 06-27-2012
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44- it is kaposi... the spindle shaped cells with longitudinal fan like array...

hav a look here....

http://bestpractice.bmj.com/best-pra...mage/bp/2.html
Attached Thumbnails
NBME 5 Block 1 discussion-1031-2_default.jpg  
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Old 07-19-2012
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Can any one help me with Q24,The chubby boy question?Ans is Iron in key but I cant understand
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