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Old 05-15-2013
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Default Discussing NBME Form 15 Questions

Due to copyright laws, I can't post the full questions or its details. So, only some pointers just to discuss them, not in anyway reproducing them. I think this is allowed, right? {To moderators, if you think otherwise, and it violates something, please remove it}

My score was 252/19 mistakes. On to questions that I screwed up:

1. Whats the risk of fetus if the mom is on Cocaine? I chose Heart Defect, but it was wrong.

2. Anyone managed to do the NY/SF question? I sure crapped my pants when I saw it I have the data for it, so if anyone wants to solve it, let me know. Cant post it here, copyright problems..

3. Concentration of Insulin in DM2 . This was a silly mistake, it suppose to be high, ..I wanna know if it is 40 or 80.

4. I think this one we know from the discussion in elsewhere forums..OGP poisoning, first thing after Airway securing is Atropine, not Pralidoxime.

5. Unpasterized cheese, Gram+ cocobacilli. I chose Bacillus cerues, but wrong. I missed the point that it was recovered from Blood. Options were: Camplybacter, Clostridium, Listeria, Ecoli, Salmonella, Staph, Vibrio, Yersinia.

6.Study, for Dextromethorphan use and cough. what limited the validity? I chose "Study location limited to emergency department", but this was wrong. Other options were Limited number of participants; Marginal statistical significance; Lack of blinding between groups; Subjective nature of the study(but this is wrong, in another thread)

7.Pharmacotherapy for GERD. I chose metoclopramide over Omeprazole, but this was obviously wrong. I was thinking metoclopromide will increase the LES tone, and prevent reflux, but apparently its wrong. So the answer has to be omeprazole then. Other options were Cimetidine, sucralfate, Calcium carbonate,

8. Again, another nutcracker, and I feel like an idiot. Down, with symtoms of leukemia. What is seen on BM? I chose "Megaloblastosis", since the child is less than 5 year old and is increased risk for M7, but this is wrong. Its sure "Excess Lymphoblasts". I guess the distinction of the risk for Down in terms of age is a minor detail, not relavent (i.e. Less than 5 = Risk of M7 , More than 5 year old = Risk of ALL)

9. Huge heart shown. Hx of HTN. I chose "Infarct", since there was a red mark under the LV ventricle. But, its wrong. I think it was "hypertrophy". The size of the heart is 650g.

10. Kid at 2 month, decreasing Hb/Ht. 3 columns for his CBC at 24hours/1week/1month. I chose "congenital CMV infection", wrong again!

11. This was a bummer, since I was so sure its right. Patient has hypokinesia of LV post wall on increasing activity on stress echo. Reason for this finding? I chose "Increased myocardial oxygen consumption". Crap! I think it was "Increased LV end diastolic pressure"

12. Another crapy question. Got shot in abdomen, patient requires decreasing dose of Warfarin 6 weeks later. I chose "Septic shock caused by Ecoli", but wrong!

13. Patient, cries after loss of sister, and then has a headache. I chose "abnormal grief response". I think its "normal emotional response"

14. Female Hx of fever, Lower quadrant pain, Leukocytosis, Increase hcg . Pic shows a cavity, lookling like a mole. I chose "Hydatiform mole", but I think it was Choriocarcinoma, since the entire wall was invaded. Or was it Ectopic?

15. Function of IkB in NF-KB. I know this now, its "Release NFkB after undergoing phosphorylation"

The other 4 questions were my silly mistakes. G+ve messed up, Teratoma is a Germ cell tumor, not Sex chord etc.

Aright, let me know what you guys answered. If you want to know an answer to some question, let me know and I'll try to remember my response.

Thanks.
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Old 05-15-2013
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I don't have access to the original questions so this is just by memory. I only have the questions that I myself got wrong, which surprisingly, is different from what you got wrong. I missed 26.

5. Unpasterized cheese - Listeria (this one is actually in FA)
6. Lack of blinding - there was no placebo group
9. big heart one was hypertrophy
11. yep "Increased LV end diastolic pressure"
13. yep "normal emotional response"
15. yep, I wish FA covered NF-KB more considering I keep seeing this on NBMEs

If you have the original questions with answer choices, maybe I can remember some more. Then again, just because I got the question right the first time doesn't mean I will get it right again.

Can you help me with these?

1. The question on histologic features of malignant lymphocytes and its cell markers. Choices were "activated cytolytic effector T-cells in the circulation" "mature IgM secreting B-cells in the lymph node" "mature immunoglobulin secreting plasma cells in the lymph node" "pre-B progenitor of mature B lymphocytes in the bone marrow" "T-cell thermocytes localized to the thymic cortex"

2. Lady gets brought to emergency department after being exposed to aerosolized I-125. What is the initial treatment? Choices were levothyroxine, liothyronine, methimazole, potassium iodide, and PTU.

3. Why does deoxygenated blood carry more CO2 for a given PCO2 than oxygenated blood?
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Old 05-15-2013
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Quote:
1. The question on histologic features of malignant lymphocytes and its cell markers. Choices were "activated cytolytic effector T-cells in the circulation" "mature IgM secreting B-cells in the lymph node" "mature immunoglobulin secreting plasma cells in the lymph node" "pre-B progenitor of mature B lymphocytes in the bone marrow" "T-cell thermocytes localized to the thymic cortex"

2. Lady gets brought to emergency department after being exposed to aerosolized I-125. What is the initial treatment? Choices were levothyroxine, liothyronine, methimazole, potassium iodide, and PTU.

3. Why does deoxygenated blood carry more CO2 for a given PCO2 than oxygenated blood?
1. This is "T-Cell thermocytes localized in the thymic cortex". This case was Acute Lymphoblastic lymphoma, a T-cell lymphoma. We know it cause it was negative for CD4+/CD8/All B cell markers, and All B cell chain markers. It was positive for TCR gene rearrangment, meaning it was in the process to become a TCell. Note, thymus is also the place where you still dont have CD4/CD8. I mean, you start popping those receptors once you get into the positive selection aspect of T-Cell maturation, then you will have both CD4/CD8 receptors. Actually, to be more precise, T-Cells leaving the Bone Marrow have NO CD4/CD8 receptors. They only bring them up in cortex.

2. Potassium Iodide. This is in UW. You give KI anytime you ingest a heavy isotope or are exposed to radiation. It competes with the Iodide pump in thyroid, preventing the uptake of the Radioactive Isotope.

3. Because deoxygenated blood has more H+ buffering capacity. I.e:
Increase C02 and tissue end, reacts with carbonic anhydrase in RBC, and gets converted to HC03, which is then effluxed:
C02+H20=H2CO3=H+ & HCO3-

Therefore, at any time, CO2 can be converted and transported as bicarbonate. This is not true for arterial O2, because remember, Hb is stabalized in arterial blood by O2 alone. In deoxygenated blood, Hb is stabalized by salt bridges(Histidine residues get protonated) and ionic bonds(2,3-DPG links adjacent histidine residues). The protons that are released in the reaction of carbnoic anhydrase are used to make these salt bridges. This shifts the equilibrium of the equation to right, making more HC03-, and hence converting more C02(Le Chat's principle from General Chemistry)

This is my explanation for it. I backed it up from UW notes, and it makes sense.

I hope this helps. Let me know if you have other doubts, and I'll try my best to reply as soon as i can.
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Old 05-15-2013
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this is illegal.

do not post these on this forum. check the copy right policy.
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Ah, now I understand. Thank you for the wonderful explanations. Been banging my head over it for a while.
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Old 11-16-2013
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Default increased LV diastloic pressure

I got it wrong
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