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Old 05-06-2012
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Default NBME Form 6 Block 4 Discussion

Q3.
A 22-year-old woman who is a marathon runner has a stress fracture of the tibia. she participates in a study in which bone density is measured and is found to have decreased bone density. which of the following is the most likely cause?
a. calcitonin deficiency
b. cortisol deficiency
c. estrogen deficiency
d. growth hormone deficiency
e. insulin deficiency
f. parathyroid hormone deficiency
g. parathyroid hormone excess
h. thyroid hormone deficiency
i. thyroid hormone excess
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2. A 68-year-old woman is brought to the emergency department by her husband 3 hours after the onset of severe pain in the middle of her lower back after carrying groceries. She takes no medications, and her never received hormone replacement therapy. Physical examination shows tenderness over the lumbosacral spine. Neurologic examination shows no focal findings. Which of the following is most likely on xray of the spine?

A) Compression fracture of L4
B) Facet joint dislocation at L3-L4
C) Fracture of a lateral process of L1
D) Herniation of the L-S1 intervetebral disc
E) Spinal stenosis at T12
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Q 6.

Which of the following is the median number of episodes of urinary tract infection for children (n= 100) in the sample shown in the graph ?


a. 0
b. 1
c. 2
d. 3
e. cannot be determined by this graph
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Old 05-06-2012
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Quote:
Originally Posted by cingulate.gyrus View Post
Q3.
A 22-year-old woman who is a marathon runner has a stress fracture of the tibia. she participates in a study in which bone density is measured and is found to have decreased bone density. which of the following is the most likely cause?
a. calcitonin deficiency
b. cortisol deficiency
c. estrogen deficiency
d. growth hormone deficiency
e. insulin deficiency
f. parathyroid hormone deficiency
g. parathyroid hormone excess
h. thyroid hormone deficiency
i. thyroid hormone excess
I got this question right on NBME 6 since its not showing up on my extended. I believe this was choice and here is my reasoning:
C- estrogen deficiency.
-Women
-Marathon runner- most extreme athletes don't have period.
-Its almost as if she has postmenopausal osteoporosis- increase bone resorption due to decrease estrogen

...Hope I was right....
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Q8.
Four days after admission to the hospital with multiple fractures sustained in a motor vehicle collision, a 27-year-old man has the sudden onset of shortness of breath. His respiration are 30/min. Doppler ultrasonography of the lower extremities shows deep vein thrombosis, and a spiral CT scan of the chest shows evidence of multiple subsegmental pulmonary emboli. Anticoagulant therapy is begun. One week later, a follow-up CT scan of the chest is done to evaluate atypical chest pain. Results show no abnormalities and the pain was considered to be musculoskeletal. Collateral circulation from which of the following best explains the lack of identifiable pulmonary parenchymal infarcts in this patient?

A. Bronchial arteries
B. Bronchial veins
C. Pulmonary arteries
D. Pulmonary veins
E.. Superior vena cava
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Quote:
Originally Posted by islandcrazy View Post
I got this question right on NBME 6 since its not showing up on my extended. I believe this was choice and here is my reasoning:
C- estrogen deficiency.
-Women
-Marathon runner- most extreme athletes don't have period.
-Its almost as if she has postmenopausal osteoporosis- increase bone resorption due to decrease estrogen

...Hope I was right....
Thanks for that confirmation of answerr..
In answer key from the net it is given as a - calcitonin..I was confused.


This is known as female athlete triad..

Female Athlete Triad is a syndrome in which
eating disorders (or low energy availability)
amenorrhoea/oligomenorrhoea and
decreased bone mineral density (osteoporosis and osteopenia) are present.


Osteoporosis
Low estrogen levels and poor nutrition, especially low calcium intake, can lead to osteoporosis, the third aspect of the triad. This condition can ruin a female athlete's career because it may lead to stress fractures and other injuries.
Immediate Effects of Low Bone Density. Patients with female athlete triad get osteoporosis due to hypoestrogenmia, or low estrogen levels which is part of amenorrhea. With estrogen deficiency, the osteoclasts live longer and are therefore able to resorb more bone. In response to the increased bone resorption, there is increased bone formation and a high-turnover state develops which leads to bone loss and perforation of the trabecular plates. As osteoclasts break down bone, patients see a loss of bone mineral density. Low bone mineral density renders bones more brittle and hence susceptible to fracture. Because athletes are active and their bones must endure mechanical stress, the likelihood of experiencing bone fracture is particularly high.
Additionally, because those suffering with female athlete triad are also restricting their diet, they may also not be consuming sufficient amounts vitamins and minerals which contribute to bone density; not getting enough calcium or vitamin D further exacerbates the problem of weak bones.
Long Term Effects of Low Bone Density. Bone mass is now thought to peak between the ages of 18-25. Thus, behaviors which result in low bone density in youth could be detrimental to an athlete’s bone health throughout her lifetime

Reference and thanks to wikepedia too..

Last edited by cingulate.gyrus; 05-06-2012 at 10:01 PM.
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Q 15
A 24-year-old woman with a 2-year history of AIDS and a 4-month history of Tb comes to the physician for a follow-up exam. Current meds include antiretroviral therapy and antituberculosis therapy. Her vital signs are within normal limits. Physical exam shows no abnormalities except for muscular wasting. Results of a PPD skin test are nonreactive. The presence of which of the following conditions in this patient is the most likely cause of the PPD skin test results?

A) Granulocytopenia
B) Hypocomplementemia
C) Hypogammaglobulinemia
D) Lymphocytopenia
E) Thrombocytopenia
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Q 16.
3-A case control study is performed to determine the association between brain tumors and cell phone use. The results show an odds ratio of4.3(95% confidence interval: 0.9-8.2) for an association between brain tumors and cell phone use. Assume that 99% confidence interval was computed rather than 95% confidence interval. Which of the following statement best describes the size of the 99% confidence interval compared to the 95% confidence interval?
A. Larger
B. Smaller
C. The same
D. Can not be determined from the information given.
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Old 05-07-2012
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Refer for questions..

http://www.sikhstudentassociation.co...E6/6_4nbme.pdf
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Old 05-07-2012
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Q 32.

A 37-year-old woman has a 3-year history of progressive dementia and writhing movements in all four extremities. Her father died of a similar illness. Which of the following structures is most likely to be involved?
A ) Cerebellar hemisphere
B ) Cingulate (limbic) motor cortex
C ) Neurons of the striatum
D ) Pigmented neurons of the substantia nigra
E ) Primary motor cortex (area 4)
F ) Subthalamic nucleus
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