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  #1  
Old 02-24-2012
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Arrow NBME 5 Block 2 discussion

Q 7:

Ok so yes it is malignant otitis externa but the stem is confusing. Shouldn't there be drainage from the ear and fever????



Q 14:

Very confusing picture, I can't tell whether those are Z lines or M lines. Which one is it so I know I should associate gap junctions with it. I'm assuming it is Z lines, but not sure.



Q 15:

Don't think A is the right answer, but it does seem the best possible answer out of the rest. Obviously she is suffering from Grief, but the fact that she says he visits her every night and talks to her is concerning. That threw me off. Can someone explain this a little more....



Q17:

Ok so I have a related question to this one. Normally Glucagon causes phosphorylation and Insulin causes dephosphorylation. I was thinking about this after doing this question. How the hell can insulin dephosphorylate when it causes Tyrosine Kinase activity (same as PDGF in this question)????



Q18:

How is this a germline mosaic??? The fact that her mother has this disease she is at increased risk of being a carrier. What does germline mosaic have to do with this??



Q 36:

I think the answer is E. The thought of G6PD crossed my mind but I don't think they are talking about it here. In the stem it says spontaneous oxidation of oxyhemoglobin. Oxidized form of hemoglobin is Fe3+ or methemoglobin. To reduce methemoglobin you either need methylene blue or ascorbic acid (vit. C).

The other thing that also sticks out is where it says reduced oxygen metabolites. Correct me if I'm wrong but reduced oxygen metabolites would not be dangerous, it is the oxidized oxygen metabolites that are dangerous.



Q 38:

I think the answer is D.
High suicide risk.
mood instability (more like Bipolar)
poor impulse control (manic episode)
Increased libido and promiscuity (in bipolar multiple partners is key)

The clincher for me is where they mention that she tried multiple therapies but with only transient relief. The anti-depressants/anxiolytics will only help her in the depressive phase and will not work in the manic phase. While the neuroleptics will only help her in the manic phase and not in the depressive. This is probably why she never got full control.
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Bump....waiting for hitman.
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Qs 7 ...... hmm , yes may be there should be fever , but it seems there is usually no fever .... see the link below , symptoms dont say fever

http://emedicine.medscape.com/article/763918-clinical

Qs 14 its a Intercalated disc and has gap junctions in it see this

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

Qs 15 .. insulin dephosphorylates and PDGF causes phosphorlyation by kinases , dont know how , but phosphatese is the only one that can reverse it ...

Qs 18 , yes germ line mosaic leads to random inactivation of X , so it means any of the affected X or normal X can be transfered , its the same reason why females are carriers in X linked disease ...

Qs 36 well its G6pd , see the link it say Vit C is helpful but not usefull without glutathione , so glutathione is maintained by G6pd ...

http://www.ncbi.nlm.nih.gov/pubmed/19178455

Qs 38 is E ...... selfmutilation , unstable relations .point to E .. see FA pg 448 .... dont know whether the anxiolytics , neurolptics were given together or seperately so difficult to say ..bipolar , but still symptoms very clear for E
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hey whats the ans for 19 ?? its B ??
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Quote:
Originally Posted by Hitman View Post
Qs 15 .. insulin dephosphorylates and PDGF causes phosphorlyation by kinases , dont know how , but phosphatese is the only one that can reverse it ...
This is bugging the hell out of me. If they both work on the same receptors, how can they work through opposite mechanisms?????


Quote:
Originally Posted by Hitman View Post
Qs 38 is E ...... selfmutilation , unstable relations .point to E .. see FA pg 448 .... dont know whether the anxiolytics , neurolptics were given together or seperately so difficult to say ..bipolar , but still symptoms very clear for E
Still think its Bipolar.

Splitting is a MAJOR defense mechanism of borderline, but its not mentioned here.

She is suicidal, in Bipolar there is a HIGH suicide risk. No mention of suicide in Borderline.

In the stem it says she has brief INTENSE romantic relationships. That fits the increased energy and emotion in a manic episode rather than an unstable relationship in borderline.
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hey whats the ans for 19 ?? its B ??
same as key....C

The key here is pain free. Both drugs give her relief so they are equally as efficacious, just that their potencies (dose) and toxicities are different.
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This is bugging the hell out of me. If they both work on the same receptors, how can they work through opposite mechanisms?????




Still think its Bipolar.

Splitting is a MAJOR defense mechanism of borderline, but its not mentioned here.

She is suicidal, in Bipolar there is a HIGH suicide risk. No mention of suicide in Borderline.

In the stem it says she has brief INTENSE romantic relationships. That fits the increased energy and emotion in a manic episode rather than an unstable relationship in borderline.
Hey its nots Bipolar , just look at the words in the Qs , they picked up word by word from FA ... selfmutilation , mood instability , poor impulse control ,unstable interpersonal relations , female ... all point to borderline ...
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same as key....C

The key here is pain free. Both drugs give her relief so they are equally as efficacious, just that their potencies (dose) and toxicities are different.

oh , yup missed that .......
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Hey its nots Bipolar , just look at the words in the Qs , they picked up word by word from FA ... selfmutilation , mood instability , poor impulse control ,unstable interpersonal relations , female ... all point to borderline ...
ok..........
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Originally Posted by Hitman View Post
Qs 7 ...... hmm , yes may be there should be fever , but it seems there is usually no fever .... see the link below , symptoms dont say fever

http://emedicine.medscape.com/article/763918-clinical
Found this.

Otalgia without hearing loss or fever is observed in adults with external otitis, dental abscess, or pain referred from the temporomandibular joint.

So I guess that confirms its malignant otitis externa.
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  #11  
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Hi,is this from NBME offline? if so you have any linkl? how do i make a fresh post on this forum?? thanks pal.
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Hi,is this from NBME offline? if so you have any linkl? how do i make a fresh post on this forum?? thanks pal.
go to step one forum , click on start thread .....
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Can someone explain me Q 42 to me. What is the meaning of all the options giving there
Also I dont understand Q4 why cant it be A
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Quote:
Originally Posted by mohitkmc View Post
Can someone explain me Q 42 to me. What is the meaning of all the options giving there
Also I dont understand Q4 why cant it be A
Q4:

In the stem it says that the phage picked up the E.Coli chromsome rather than its own. So it will be able to infect other cells, but it won't be able to replicate since its own chromosome is not present.


Q42:

You just have to know what each of those terms means. Basically as physicians we have to encourage patients to make their own decisions (Autonomy), but we also have to be weary that sometimes those decisions might cause more harm than good (Maleficance).

Its good that the mother wants to make her own decisions, but in this case her decision might cause more harm as it is an invasive procedure and they will probably not find anything wrong at all. So have to be weary of performing an unnecessary procedure even though the patient might wish it.
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Old 02-25-2012
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go to step one forum , click on start thread .....
Thanks buddy.
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Q15: why not B?

Q18: im not good at all those terms. how do i approach this question?

Q29: why not B?

Q31: is diarrhea loss of acidic or basic fluid?

Q40: why not B? isnt it more likely to be endocervical cancer than exocervical cancer? and the endocervix is columnar epithelium, therefore an adenocarcinoma?

Q43: help?

Q45: help?
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Quote:
Originally Posted by haga View Post
This is bugging the hell out of me. If they both work on the same receptors, how can they work through opposite mechanisms?????
remember, the insulin receptor activates (via phosphorylation) the phosphorylases, this promotes glycolysis.
glucagon and such activate (via dephosphorylation) the kinases, this promotes gluconeogenesis.

i remember this from kaplan. i dont have the book on me so i cant refer to a page number but its discussed well under the insulin receptor.
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Quote:
Originally Posted by Dr.NickRiviera View Post
Q15: why not B?

Q18: im not good at all those terms. how do i approach this question?

Q29: why not B?

Q31: is diarrhea loss of acidic or basic fluid?

Q40: why not B? isnt it more likely to be endocervical cancer than exocervical cancer? and the endocervix is columnar epithelium, therefore an adenocarcinoma?

Q43: help?

Q45: help?
Qs 15 its in their culture to talk to dead people , so shes normal

Qs 18 , you must have figured out it a X linked disorder , so it has females as carriers becoz of mosaic pattern of X inactivation as they have two X

Qs 29 Hb increase will appear after new cells have entered the system , thus the reticulocytes will appear first , which when increased to good conc will show increase HB ...

Qs 31 , diarrhea is base loss so acidosis , below duodenum any loss is base , vomiting is acid loss

Qs 40 it is SCC becoz HPV causes squamous metaplasia in the cervix so no adenoCA .. if CA arises from endometrium itself by tamoxifen or such then its endometrial CA

Qs 43 see FA pg 83 , if heterozygous greater than the combination of two like A = 0.2 B= 0.2 AB should be 0.04 but its 0.16 so this is due to linkage disequib

Qs 45 its coxsackie A causing hand foot mouth disease , young child + swollen thumb see FA pg 168 ..
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Quote:
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Qs 40 it is SCC becoz HPV causes squamous metaplasia in the cervix so no adenoCA .. if CA arises from endometrium itself by tamoxifen or such then its endometrial CA
.
doesn't HPV cause the whole CIN1, CIN2, CIN3, in situ and invasive CA thing? which is a dysplasia of the cell type already there?

Quote:
Originally Posted by Hitman View Post

Qs 45 its coxsackie A causing hand foot mouth disease , young child + swollen thumb see FA pg 168 ..
so anytime there is a young kid with a swollen thumb, thats enough to determine its hand-foot-mouth disease? i dont see much on p.168 discussing it.
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Quote:
Originally Posted by Dr.NickRiviera View Post
doesn't HPV cause the whole CIN1, CIN2, CIN3, in situ and invasive CA thing? which is a dysplasia of the cell type already there?



so anytime there is a young kid with a swollen thumb, thats enough to determine its hand-foot-mouth disease? i dont see much on p.168 discussing it.
Sorry , its Squamous dysplasia , it starts at the junction at endo and ecto cervix , precisely where we take the pap smear , affecting the squamo columnar junction so cause SCC the most common type , next is the Adeno CA , but nothing has been said of what is seen in the slide , so its basically selecting the most common one which is SCC

Qs 45 ... since it is a small kid with vesicular skin lesion .. and only viruses are the options , so this fits the bill , there can be number of causes but among viruses , this is the most common one
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Sorry , its Squamous dysplasia , it starts at the junction at endo and ecto cervix , precisely where we take the pap smear , affecting the squamo columnar junction so cause SCC the most common type , next is the Adeno CA , but nothing has been said of what is seen in the slide , so its basically selecting the most common one which is SCC

Qs 45 ... since it is a small kid with vesicular skin lesion .. and only viruses are the options , so this fits the bill , there can be number of causes but among viruses , this is the most common one
ok makes sense
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Default Pls kindly explain these 2 question :-(

17. A 69-year-old woman is brought to the emergency department 1 hour after the sudden onset of crushing, substernal chest pain and nausea. Physical examination shows
pallor and diaphoresis An ECG and an evaluation of serum cardiac enzyme activity confirm a diagnosis of a myocardial infarction of the anterior wall Activation of platelets
and segmented neutrophils during thrombogenesis in this patient caused the release of cytokines, including platelet-derived growth factor. The mitogenic signal provided by
this cytokine to smooth muscle cells at sites of vascular injury in this patient is most likely to be inhibited by which of the following intracellular enzymes?

a.Aminotransferase
b.Glycosylhydrolase
c.Kinase
d.Lipase
e.Peroxidase
f.Phosphatase





28.A 17 -year-old girl is evaluated because of a "boil" on her left shoulder. Examination shows an erythematous, painful, ftuctuant lesion; a yellow-green liquid material is
dramed surgically. The pam and erythema gradually subside. Which of the following cells contnbutes most to the t1ssue changes present in the les1on 5 days after dramage?
A) Eosinophils
B) Lymphocytes
C) Macrophages
D) Neutrophils
E) Plasma cells


Pls kindly explain no 17...I don't know why answer is F and why choos Macrophages in no.28.
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Quote:
Originally Posted by kzwmkn View Post
17. A 69-year-old woman is brought to the emergency department 1 hour after the sudden onset of crushing, substernal chest pain and nausea. Physical examination shows
pallor and diaphoresis An ECG and an evaluation of serum cardiac enzyme activity confirm a diagnosis of a myocardial infarction of the anterior wall Activation of platelets
and segmented neutrophils during thrombogenesis in this patient caused the release of cytokines, including platelet-derived growth factor. The mitogenic signal provided by
this cytokine to smooth muscle cells at sites of vascular injury in this patient is most likely to be inhibited by which of the following intracellular enzymes?

a.Aminotransferase
b.Glycosylhydrolase
c.Kinase
d.Lipase
e.Peroxidase
f.Phosphatase





28.A 17 -year-old girl is evaluated because of a "boil" on her left shoulder. Examination shows an erythematous, painful, ftuctuant lesion; a yellow-green liquid material is
dramed surgically. The pam and erythema gradually subside. Which of the following cells contnbutes most to the t1ssue changes present in the les1on 5 days after dramage?
A) Eosinophils
B) Lymphocytes
C) Macrophages
D) Neutrophils
E) Plasma cells


Pls kindly explain no 17...I don't know why answer is F and why choos Macrophages in no.28.
17. i was thinking C or F. because i remember the insulin receptor (which uses intrinsic kinase activity like growth factors do) uses a cascade of kinases to ultimately phosphorylate and activate phosphorylases. so im not sure if i fully understand what they are asking, but the answer is either C or F depending on what they are asking.

28. in necrosis, neutrophils come in days 1-3 and macrophages come in days 3-7. like in an MI.
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Q8: Please can someone tell why it is not D: Homologous site & why it is B: Endonuclease in case of recombination?
The way I understood is was that Recombination requires a homologous segment of Chromosome while Transposition requires only an Insertion site.

Q32: Shouldn't Topoisomerase knick both DNA strands?

Q41: Shouldn't hypercalcemia cause diarrhea and not constipation?

Q42: Why isn't the answer a: Autonomy vs maleficence and why is it d: Beneficence vs maleficence.
The way I understand it beneficence should come into play when there is a risky procedure that we have to do & then have to assess risk vs benefit.
This question just weighs the risks of an unnecessary procedure against the patients wishes.

I'll be very grateful for explanations.
Thanks!
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Originally Posted by drssbaz View Post
Q8: Please can someone tell why it is not D: Homologous site & why it is B: Endonuclease in case of recombination?
The way I understood is was that Recombination requires a homologous segment of Chromosome while Transposition requires only an Insertion site.

Q32: Shouldn't Topoisomerase knick both DNA strands?

Q41: Shouldn't hypercalcemia cause diarrhea and not constipation?

Q42: Why isn't the answer a: Autonomy vs maleficence and why is it d: Beneficence vs maleficence.
The way I understand it beneficence should come into play when there is a risky procedure that we have to do & then have to assess risk vs benefit.
This question just weighs the risks of an unnecessary procedure against the patients wishes.

I'll be very grateful for explanations.
Thanks!
Hey i think you have got a lot of mistakes in your answer key

Q8
It IS D and thats what my key says. you're right

Q32
Yes it does nick both the strands but thats not an option. The only option that makes sense is a right?

Q41
Nope, hypercalcemia does not cause diarrhoea it causes constipation. Im not exactly sure about the mechanism but the way i remember patients with multiple myeloma also present with constipation due to raised serum calcium levels

Q42
Yes, the answer is probably A. and thats what my key says!
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Number 4, can someone explain it in a little bit more detail please?

15, A does not make sense to me at all!! but the other options are dumb too

18 so what is the answer??? C or F? I thought it was F!!

24 i honestly dont know what REPERTOIRE means!! but i guessed it means like a wide variety??

34. ok yeah the india ink gives away the answer BUT the CSF findings do not agree! Lymphocytic pleocytosis, normal glucose and increased proteins go with viral!!! isnt the glucose supposed to be decreased in fungal??

45 i guessed its hand foot and mouth too but just by looking at that picture we're suppsoed to conclude that it is so ??
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Hey i think you have got a lot of mistakes in your answer key

Q8
It IS D and thats what my key says. you're right

Q32
Yes it does nick both the strands but thats not an option. The only option that makes sense is a right?

Q41
Nope, hypercalcemia does not cause diarrhoea it causes constipation. Im not exactly sure about the mechanism but the way i remember patients with multiple myeloma also present with constipation due to raised serum calcium levels

Q42
Yes, the answer is probably A. and thats what my key says!
Can you send me your answer key? Mine seems to have too many mistakes actually. We can discuss better then. My e mail is golumotu4ever@yahoo.com
Thanks!
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Can you send me your answer key? Mine seems to have too many mistakes actually. We can discuss better then. My e mail is golumotu4ever@yahoo.com
Thanks!
I PM'ed u the link
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Quote:
Originally Posted by numbndumb View Post
Number 4, can someone explain it in a little bit more detail please?

15, A does not make sense to me at all!! but the other options are dumb too

18 so what is the answer??? C or F? I thought it was F!!

24 i honestly dont know what REPERTOIRE means!! but i guessed it means like a wide variety??

34. ok yeah the india ink gives away the answer BUT the CSF findings do not agree! Lymphocytic pleocytosis, normal glucose and increased proteins go with viral!!! isnt the glucose supposed to be decreased in fungal??

45 i guessed its hand foot and mouth too but just by looking at that picture we're suppsoed to conclude that it is so ??
4- normally the bacteriophages released will hav the protein coat of T7 and T7 chromosome...so they infect and replicate normally...but the odd one progeny has a coat of T7 so it can attach to the ecoli but the chromosome it has is of ecolli and not of T7.. so no T7 produced from that odd phage..

15- yup, no sense at all...

18- both are tru but i think C fits the bill.. coz they are asking us why is the risk of her carrying the gene more... as the mother doesnt hav it ,it has got to be germline mosicism... if the Q were "how can she get the disease?" then F wud be more appropriate... but thats just how i see it...
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4- normally the bacteriophages released will hav the protein coat of T7 and T7 chromosome...so they infect and replicate normally...but the odd one progeny has a coat of T7 so it can attach to the ecoli but the chromosome it has is of ecolli and not of T7.. so no T7 produced from that odd phage..

15- yup, no sense at all...

18- both are tru but i think C fits the bill.. coz they are asking us why is the risk of her carrying the gene more... as the mother doesnt hav it ,it has got to be germline mosicism... if the Q were "how can she get the disease?" then F wud be more appropriate... but thats just how i see it...
Q4 ok that makes sense .. but they it still has some T7 chrosomoes doesnt it?? thats wat confused me but yes u made sense!

Q18 still dont get it. actuallt i never really understood what mosaicism meant
thanks
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  #31  
Old 04-30-2013
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can anybody send me NBME form 5 blocks
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  #32  
Old 05-30-2014
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Q42: What do the other terms mean? Thanks
Quote:
Originally Posted by haga View Post
Q4:

In the stem it says that the phage picked up the E.Coli chromsome rather than its own. So it will be able to infect other cells, but it won't be able to replicate since its own chromosome is not present.


Q42:

You just have to know what each of those terms means. Basically as physicians we have to encourage patients to make their own decisions (Autonomy), but we also have to be weary that sometimes those decisions might cause more harm than good (Maleficance).

Its good that the mother wants to make her own decisions, but in this case her decision might cause more harm as it is an invasive procedure and they will probably not find anything wrong at all. So have to be weary of performing an unnecessary procedure even though the patient might wish it.
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