NBME 15 discussion - USMLE Forums
USMLE Forums Logo
USMLE Forums         Your Reliable USMLE Online Community     Members     Posts
Home
USMLE Articles
USMLE News
USMLE Polls
USMLE Books
USMLE Apps
Go Back   USMLE Forums > USMLE Step 1 Forum

USMLE Step 1 Forum USMLE Step 1 Discussion Forum: Let's talk about anything related to USMLE Step 1 exam


Reply
 
Thread Tools Search this Thread Display Modes
  #1  
Old 03-20-2014
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 73
Threads: 3
Thanked 58 Times in 24 Posts
Reputation: 68
Default NBME 15 discussion

Hello. Please, can anybody explain this question?

The scheme to this question illustrate AD-inheritance, but inspite of being healthy, her son is ill.
A 45-year-old woman (lll,7) comes to the physician for a routine health maintenance examination. Several people in her family, including her son (lV,3), have hereditary telangiectasia. A pedigree is shown. Physical examination and full medical evaluation show no abnormalities. Which of the following best explains the reason for this patient's health?
A) Gonadal mosaicism
B) Incomplete penetrance
C) Nonpaternity
D) Somatic mosaicism
E) Variable expressivity
Reply With Quote Quick reply to this message
The above post was thanked by:
drzamzam (09-09-2015)



  #2  
Old 03-20-2014
usmle1's Avatar
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 71
Threads: 2
Thanked 33 Times in 18 Posts
Reputation: 43
Default

Quote:
Originally Posted by Kras View Post
Hello. Please, can anybody explain this question?

The scheme to this question illustrate AD-inheritance, but inspite of being healthy, her son is ill.
A 45-year-old woman (lll,7) comes to the physician for a routine health maintenance examination. Several people in her family, including her son (lV,3), have hereditary telangiectasia. A pedigree is shown. Physical examination and full medical evaluation show no abnormalities. Which of the following best explains the reason for this patient's health?
A) Gonadal mosaicism
B) Incomplete penetrance
C) Nonpaternity
D) Somatic mosaicism
E) Variable expressivity
i dont have this question in my wrong questions og nbme15 it means i have selected incomplete penetrance the answer ...she must have the disease causing mutation but incomplete penetrance..specially in AD conditions
Reply With Quote Quick reply to this message
The above post was thanked by:
fido256 (07-27-2014), Kras (03-20-2014)
  #3  
Old 03-20-2014
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 73
Threads: 3
Thanked 58 Times in 24 Posts
Reputation: 68
Default

Have anybody got right this question?

A 56-year-old woman comes to the physician because of a 3-week history of progressive difficulty swallowing. When her symptoms began, she felt that bread and larger pieces of meat were getting stuck in her chest before passing through completely, but now she is having difficulty swallowing all foods and some liquids. Physical examination shows normal oral coordination and a nontender abdomen. An x-ray obtained after a barium swallow shows an irregular mass at the gastroesophageal junction. A photomicrograph of a biopsy specimen obtained via esophagogastroduodenoscopy is shown. Chronic infection with which of the following pathogens is the most likely cause of the histologic findings in this patient?
A) Clonorchis sinensis
B) Cytomegalovirus
C) Entamoeba histolytica
D) Helicobacter pylori
E) Mycobacterium tuberculosis

Helicobacter pylori prevents esophageal cancer, not cause. http://en.wikipedia.org/wiki/Helicobacter_pylori

The latest studies, however, suggest that the presence of H. pylori in the stomach may be beneficial, reducing the prevalence of asthma,[49] rhinitis,[49] dermatitis,[49] inflammatory bowel disease,[49] gastroesophageal reflux disease[50] and esophageal cancer[50] by influencing systemic immune responses.

Mounting evidence suggests that H. pylori has an important role in protecting from some diseases. The incidence of acid reflux disease, Barrett's esophagus, and esophageal cancer have been rising dramatically at the same time as H. pylori's presence decreases.
Reply With Quote Quick reply to this message
  #4  
Old 03-20-2014
usmle1's Avatar
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 71
Threads: 2
Thanked 33 Times in 18 Posts
Reputation: 43
Default

Quote:
Originally Posted by Kras View Post
Have anybody got right this question?

A 56-year-old woman comes to the physician because of a 3-week history of progressive difficulty swallowing. When her symptoms began, she felt that bread and larger pieces of meat were getting stuck in her chest before passing through completely, but now she is having difficulty swallowing all foods and some liquids. Physical examination shows normal oral coordination and a nontender abdomen. An x-ray obtained after a barium swallow shows an irregular mass at the gastroesophageal junction. A photomicrograph of a biopsy specimen obtained via esophagogastroduodenoscopy is shown. Chronic infection with which of the following pathogens is the most likely cause of the histologic findings in this patient?
A) Clonorchis sinensis
B) Cytomegalovirus
C) Entamoeba histolytica
D) Helicobacter pylori
E) Mycobacterium tuberculosis

Helicobacter pylori prevents esophageal cancer, not cause. http://en.wikipedia.org/wiki/Helicobacter_pylori

The latest studies, however, suggest that the presence of H. pylori in the stomach may be beneficial, reducing the prevalence of asthma,[49] rhinitis,[49] dermatitis,[49] inflammatory bowel disease,[49] gastroesophageal reflux disease[50] and esophageal cancer[50] by influencing systemic immune responses.

Mounting evidence suggests that H. pylori has an important role in protecting from some diseases. The incidence of acid reflux disease, Barrett's esophagus, and esophageal cancer have been rising dramatically at the same time as H. pylori's presence decreases.
i dont have this one in my wrong questions but i may have selected CMV( i dont know why) as the answer choices if H pylori is wrong answer ..other wise i think the culprit is h pylori cause it causer GERD which can indirectly leads to adenocarcinoma of esophagus...what is your answer?? is H pylori the wrong answer ?
Reply With Quote Quick reply to this message
  #5  
Old 03-20-2014
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 73
Threads: 3
Thanked 58 Times in 24 Posts
Reputation: 68
Default

I answered C.
I thought about CMV. May be on the picture there's no cancer. And CMV-related esophagitis can be right. But there's nothing about immune status.
Reply With Quote Quick reply to this message
  #6  
Old 03-20-2014
usmle1's Avatar
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 71
Threads: 2
Thanked 33 Times in 18 Posts
Reputation: 43
Default

Quote:
Originally Posted by Kras View Post
I answered C.
I thought about CMV. May be on the picture there's no cancer. And CMV-related esophagitis can be right. But there's nothing about immune status.
ok then it is CMV ,i like the info about H pylori
Reply With Quote Quick reply to this message
  #7  
Old 03-20-2014
usmle1's Avatar
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 71
Threads: 2
Thanked 33 Times in 18 Posts
Reputation: 43
Default

Quote:
Originally Posted by usmle1 View Post
ok then it is CMV ,i like the info about H pylori
but CMV wont cause progressive dysphagia to solid and liquids .it is clearly a cancer and you are right for CMV they would have given her immune status .so i thin D is the answer
Reply With Quote Quick reply to this message
  #8  
Old 03-20-2014
usmle1's Avatar
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 71
Threads: 2
Thanked 33 Times in 18 Posts
Reputation: 43
Default

a paper says we choose the sample size to have an 80% power of detectin a 15%mean difference with a significance level (two sided ) of 5% is there really is no difference between the groups overall which of the following best represent the chance that the study will find a statistical significant difference and what is the error called
0% type 1 error
0 %type11 error
5 %typeI error
5 %typeII error
15% type1
15% type11
20% type1
20%type11
can some 1 explain this please
Reply With Quote Quick reply to this message
  #9  
Old 03-20-2014
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 73
Threads: 3
Thanked 58 Times in 24 Posts
Reputation: 68
Default

Quote:
Originally Posted by usmle1 View Post
there really is no difference
so they made type I error (alpha), 5%.
answer is C. I got wrong in this question.
Reply With Quote Quick reply to this message
  #10  
Old 03-21-2014
usmle1's Avatar
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 71
Threads: 2
Thanked 33 Times in 18 Posts
Reputation: 43
Default

Quote:
Originally Posted by Kras View Post
so they made type I error (alpha), 5%.
answer is C. I got wrong in this question.
it was really confusing because they describe type two error in the begining and ask about type I in the third line
Reply With Quote Quick reply to this message
  #11  
Old 03-21-2014
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 4
Threads: 0
Thanked 3 Times in 2 Posts
Reputation: 13
Default

Can somebody explain this question? I have no clue what is it about and which answer is correct.

3) An investigator is studying Helicobacter pylori stains isolated from the same patient over several years. The immune response to proteins produced by these strains is observed. It is found that the original H. pylori isolate from the patient expresses one protein recognized by the patient's antibodies, but subsequent isolates do not express this protein. Sequencing of the gene encoding the protein from the original and subsequent isolates is done. It is found that subsequent isolated have nine consecutive cytidine residues, whereas the original isolate has eight. The results are show.

Original isolate:
... ACC CCC CCC ACT CAA ATT GAA CCT AGC ....
... Thr Pro Pro Thr Gln lle Glu Pro Ser .....

Subsequent isolates:
... ACC CCC CCC CAC TCA AAT TGA ACC TAG ...
... Thr Pro Pro His Ser Asn STOP

Which of the following mechanisms best explains this genetic change?
A) Crossing over
B) DNA excision repair
C) Slipped-strand mispairing
D) Thymidine dimer formation
E) Transposon insertion
Reply With Quote Quick reply to this message
  #12  
Old 03-21-2014
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 4
Threads: 0
Thanked 3 Times in 2 Posts
Reputation: 13
Default

Quote:
Originally Posted by Kras View Post
Have anybody got right this question?

A 56-year-old woman comes to the physician because of a 3-week history of progressive difficulty swallowing. When her symptoms began, she felt that bread and larger pieces of meat were getting stuck in her chest before passing through completely, but now she is having difficulty swallowing all foods and some liquids. Physical examination shows normal oral coordination and a nontender abdomen. An x-ray obtained after a barium swallow shows an irregular mass at the gastroesophageal junction. A photomicrograph of a biopsy specimen obtained via esophagogastroduodenoscopy is shown. Chronic infection with which of the following pathogens is the most likely cause of the histologic findings in this patient?
A) Clonorchis sinensis
B) Cytomegalovirus
C) Entamoeba histolytica
D) Helicobacter pylori
E) Mycobacterium tuberculosis

Helicobacter pylori prevents esophageal cancer, not cause. http://en.wikipedia.org/wiki/Helicobacter_pylori

The latest studies, however, suggest that the presence of H. pylori in the stomach may be beneficial, reducing the prevalence of asthma,[49] rhinitis,[49] dermatitis,[49] inflammatory bowel disease,[49] gastroesophageal reflux disease[50] and esophageal cancer[50] by influencing systemic immune responses.

Mounting evidence suggests that H. pylori has an important role in protecting from some diseases. The incidence of acid reflux disease, Barrett's esophagus, and esophageal cancer have been rising dramatically at the same time as H. pylori's presence decreases.
I answered H.pylori and it turned out to be correct. It was interesting information about H.pylori preventing esophageal cancer but non of given choices fit here. A is associated with cholangiocarcinoma, CMV esophagitis only in immunodeficiency and I have never heard about esophageal cancer assosiation, Entamoeba no malignancy associations at all and finally TB can cause lung tumor in old cavitations, it can disseminate in immunocompromized patients but never heard of esophageal cancer assosiation.
So we are left only with H.pylori decreasing somatostatin-> gastrin increase-> high acidity-> reflux and cancer
Reply With Quote Quick reply to this message
The above post was thanked by:
drzamzam (09-09-2015), gokulramani (03-10-2016)
  #13  
Old 03-21-2014
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 4
Threads: 0
Thanked 3 Times in 2 Posts
Reputation: 13
Default

Quote:
Originally Posted by Kras View Post
Hello. Please, can anybody explain this question?

The scheme to this question illustrate AD-inheritance, but inspite of being healthy, her son is ill.
A 45-year-old woman (lll,7) comes to the physician for a routine health maintenance examination. Several people in her family, including her son (lV,3), have hereditary telangiectasia. A pedigree is shown. Physical examination and full medical evaluation show no abnormalities. Which of the following best explains the reason for this patient's health?
A) Gonadal mosaicism
B) Incomplete penetrance
C) Nonpaternity
D) Somatic mosaicism
E) Variable expressivity

Here i excluded A and D cause there should have been some affected cells, then excluded variable expression cause some presentations of disease should have been present. Between B and C nonpaternity seemed stupid because they show genetic relation in pedigree plus incomplete penetrance fits perfectly. Like hemochromatosis: you can have the mutations but be symptom free all of your life
Reply With Quote Quick reply to this message
The above post was thanked by:
drzamzam (09-09-2015)
  #14  
Old 03-21-2014
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 4
Threads: 0
Thanked 3 Times in 2 Posts
Reputation: 13
Default

I answered H.pylori and it turned out to be correct. It was interesting information about H.pylori preventing esophageal cancer but non of given choices fit here. A is associated with cholangiocarcinoma, CMV esophagitis only in immunodeficiency and I have never heard about esophageal cancer assosiation, Entamoeba no malignancy associations at all and finally TB can cause lung tumor in old cavitations, it can disseminate in immunocompromized patients but never heard of esophageal cancer assosiation.
So we are left only with H.pylori decreasing somatostatin-> gastrin increase-> high acidity-> reflux and cancer
Reply With Quote Quick reply to this message
  #15  
Old 03-28-2014
usmle1's Avatar
USMLE Forums Scout
 
Steps History: Step 1 Only
Posts: 71
Threads: 2
Thanked 33 Times in 18 Posts
Reputation: 43
Default

Quote:
Originally Posted by drrabbit View Post
Can somebody explain this question? I have no clue what is it about and which answer is correct.

3) An investigator is studying Helicobacter pylori stains isolated from the same patient over several years. The immune response to proteins produced by these strains is observed. It is found that the original H. pylori isolate from the patient expresses one protein recognized by the patient's antibodies, but subsequent isolates do not express this protein. Sequencing of the gene encoding the protein from the original and subsequent isolates is done. It is found that subsequent isolated have nine consecutive cytidine residues, whereas the original isolate has eight. The results are show.

Original isolate:
... ACC CCC CCC ACT CAA ATT GAA CCT AGC ....
... Thr Pro Pro Thr Gln lle Glu Pro Ser .....

Subsequent isolates:
... ACC CCC CCC CAC TCA AAT TGA ACC TAG ...
... Thr Pro Pro His Ser Asn STOP

Which of the following mechanisms best explains this genetic change?
A) Crossing over
B) DNA excision repair
C) Slipped-strand mispairing
D) Thymidine dimer formation
E) Transposon insertion
c )Slipped-strand mispairing may cause deletions resulting in frameshift mutation
http://highered.mcgraw-hill.com/site...ispairing.html
Reply With Quote Quick reply to this message
The above post was thanked by:
aimstep1 (12-25-2014), coliris (03-28-2014), drzamzam (09-09-2015), Elmejor23 (09-19-2015), fido256 (07-27-2014), mashhour80 (03-21-2015)



  #16  
Old 03-28-2014
USMLE Forums Addict
 
Steps History: CS Only
Posts: 100
Threads: 1
Thanked 47 Times in 35 Posts
Reputation: 57
Send a message via Skype™ to coliris
Default

Quote:
Originally Posted by usmle1 View Post
c )Slipped-strand mispairing may cause deletions resulting in frameshift mutation
http://highered.mcgraw-hill.com/site...ispairing.html
I also got this question wrong and was a bit tricky for me, so thanks for the link, NOW I really get it
__________________
If you are on Google plus (G+) join this growing USMLE community -->
To view links or images in signatures your post count must be 10 or greater. You currently have 0 posts.
Reply With Quote Quick reply to this message
  #17  
Old 04-05-2014
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 73
Threads: 3
Thanked 58 Times in 24 Posts
Reputation: 68
Default

Quote:
Originally Posted by drrabbit View Post
I answered H.pylori and it turned out to be correct. It was interesting information about H.pylori preventing esophageal cancer but non of given choices fit here. A is associated with cholangiocarcinoma, CMV esophagitis only in immunodeficiency and I have never heard about esophageal cancer assosiation, Entamoeba no malignancy associations at all and finally TB can cause lung tumor in old cavitations, it can disseminate in immunocompromized patients but never heard of esophageal cancer assosiation.
So we are left only with H.pylori decreasing somatostatin-> gastrin increase-> high acidity-> reflux and cancer
))) http://youtu.be/v0Ey776Ydgk.
Reply With Quote Quick reply to this message
The above post was thanked by:
drhouse (09-27-2014)
  #18  
Old 05-27-2014
USMLE Forums Newbie
 
Steps History: Not yet
Posts: 2
Threads: 1
Thanked 0 Times in 0 Posts
Reputation: 10
Default

A daughter brinds her 84 yr old mom with dementia, who has lost 9 lbs in 3 months who refuses to eat but is relaxed and cooperative during examination . daughter is tearful, stressed and what interventions is most appropriate ? - get started on feeding tube ; get started on TPN ; disccus stresses of patient care with the daughter and provide info regarding assistance; reassure that weight loss isnt problem cuz she is still overweight ; reassure daughter and tell her that weight loss is common in elderly.
Reply With Quote Quick reply to this message
  #19  
Old 05-27-2014
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 73
Threads: 3
Thanked 58 Times in 24 Posts
Reputation: 68
Default

discuss stresses of patient care with the daughter and provide info regarding assistance;
Reply With Quote Quick reply to this message
  #20  
Old 05-28-2014
USMLE Forums Addict
 
Steps History: Step 1 Only
Posts: 185
Threads: 58
Thanked 57 Times in 24 Posts
Reputation: 76
Default NBME 15 question

A 62 yr old man has productive cough, night sweats, and temperatures to 100 F. PPD skin test is positive but culture of sputum shows only normal flora after 2 days. A biopsy of an enlarged lymph node is done. Causal organisms are most likely to be present in which of the following cells in the specimen?

a) epithelial cells
b) fibroblasts
c) macrophages
d) neutrophils
e) t lymphocyes

Please give explanation for why the answer is macrophages
Reply With Quote Quick reply to this message
  #21  
Old 05-28-2014
USMLE Forums Addict
 
Steps History: Step 1 Only
Posts: 185
Threads: 58
Thanked 57 Times in 24 Posts
Reputation: 76
Default

A 72-year-old woman is admitted to the hospital because of an acute myocardial infarction. She undergoes cardiac catheterization. Angiography shows a left dominant circulation, and 90% narrowing of the artery supplying the diaphragmatic surface and atrioventricular node of the heart. A balloon angioplasty is scheduled during which a stent will be inserted in the narrowed vessel. The catheter and the balloon must be passed through which of the following vessels (stated in order) to reach the narrowed vessel?

Why is this the answer.

B) left coronary, circumflex, posterior interventricular (posterior descending)

Anyone have a better way of explaining?
Reply With Quote Quick reply to this message
  #22  
Old 05-29-2014
USMLE Forums Scout
 
Steps History: 1 + CK
Posts: 73
Threads: 3
Thanked 58 Times in 24 Posts
Reputation: 68
Default

Quote:
Originally Posted by ballers View Post

A 62 yr old man has productive cough, night sweats, and temperatures to 100 F. PPD skin test is positive but culture of sputum shows only normal flora after 2 days. A biopsy of an enlarged lymph node is done. Causal organisms are most likely to be present in which of the following cells in the specimen?

a) epithelial cells
b) fibroblasts
c) macrophages
d) neutrophils
e) t lymphocyes

Please give explanation for why the answer is macrophages
Repeat tuberculosis pathology.


Quote:
Originally Posted by ballers View Post

Why is this the answer.

B) left coronary, circumflex, posterior interventricular (posterior descending)

Anyone have a better way of explaining?
Normal anatomy explains. FA-2014, page 266
Reply With Quote Quick reply to this message



Reply

Quick Reply
Message:
Options

Register Now

In order to be able to post messages on the USMLE Forums forums, you must first register.
Please enter your desired user name, your email address and other required details in the form below.
User Name:
Password
Please enter a password for your user account. Note that passwords are case-sensitive.
Password:
Confirm Password:
Email Address
Please enter a valid email address for yourself.
Email Address:
Medical School
Choose "---" if you don't want to tell. AMG for US & Canadian medical schools. IMG for all other medical schools.
USMLE Steps History
What steps finished! Example: 1+CK+CS+3 = Passed Step 1, Step 2 CK, Step 2 CS, and Step 3.

Choose "---" if you don't want to tell.

Favorite USMLE Books
What USMLE books you really think are useful. Leave blank if you don't want to tell.
Location
Where you live. Leave blank if you don't want to tell.

Log-in

Human Verification

In order to verify that you are a human and not a spam bot, please enter the answer into the following box below based on the instructions contained in the graphic.



Thread Tools Search this Thread
Search this Thread:

Advanced Search
Display Modes


Similar Threads
Thread Thread Starter Forum Replies Last Post
NBME 16 discussion Kras USMLE Step 1 Forum 482 12-10-2016 12:33 PM
Discussion about NBME 6 question - dont enter if you plan to do nbme 6! modesty USMLE Step 2 CK Forum 4 07-20-2015 01:26 PM
Anybody for NBME 2 discussion? T10T12 USMLE Step 2 CK Forum 0 12-24-2013 03:20 AM
NBME 7 discussion callmerocky2 USMLE Step 1 Forum 0 06-20-2012 09:54 AM
NBME 12 discussion patient doctor USMLE Step 1 Forum 0 09-11-2011 01:19 PM

RSS Feed
Find Us on Facebook
vBulletin Security provided by vBSecurity v2.2.2 (Pro) - vBulletin Mods & Addons Copyright © 2017 DragonByte Technologies Ltd.

USMLE® & other trade marks belong to their respective owners, read full disclaimer
USMLE Forums created under Creative Commons 3.0 License. (2009-2014)