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  #1  
Old 08-08-2013
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Arrow NBME 4 discussion

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  #2  
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Normal pressure hydroceph causes corticospinal tract lesion (corona radiata compression). So how does that cause failure to inhibit voiding reflex?
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Quote:
Originally Posted by Renaissance View Post
Normal pressure hydroceph causes corticospinal tract lesion (corona radiata compression). So how does that cause failure to inhibit voiding reflex?
just remember the following:

-LMNs to the bladder are what make it contract, they continuously fire and make the bladder contract
- UMNs are the regulation, they inhibit the LMNs from always firing and you just pissing everywhere all the time

if you cut the UMN, you lose that inhibitory regulation, and you get an overactive bladder.
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So a teenage boy with mental retardation presents with abdominal pain (and splenomegaly) and has splinter hemorrhages and a systolic murmur at the upper left sternal border.
There's a high wbc count and a hugely high platelet count (around 900,000) and a high ESR

What do we do next?! (i didnt even come up with a differential for this one)

Last edited by Renaissance; 08-08-2013 at 08:20 PM.
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The double question combo of knee pain in kids.

I remember the first one was septic arthritis and so we do joint drainage or aspiration or something.

The next one i got wrong. It was the one with swelling and tenderness of the left tibial tubercle. What's the correct answer for this?

edit: just realized it could be osteomyelitis and treated by antibiotic therapy. Oh my god im such a dumbass!
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why was the answer for the 18month old kid who had a myoclonic seizure and is ok now, but high fever, a CT scan?

what does she have? initially i thought she had a febrile seizure. but she has a high temp and neck stiffness, so she has meningitis.

so then its a meningitis management question, in which case you always do lumbar puncture first THEN antibiotics (unless signs of neuro damange, then do antibiotics then CT, but seizures dont count as neuro damage right?)

i answered lumbar puncture but got it wrong
so then thought CT scan but the offline key said antibiotics.

where am i going wrong?
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Quote:
Originally Posted by Renaissance View Post
So a teenage boy with mental retardation presents with abdominal pain (and splenomegaly) and has splinter hemorrhages and a systolic murmur at the upper left sternal border.
There's a high wbc count and a hugely high platelet count (around 900,000) and a high ESR

What do we do next?! (i didnt even come up with a differential for this one)

im not sure what the clinical picture is trying to paint here, i got this wrong because i was looking for those symptoms to add up to some special disease. but at the end of the day, he has endocarditis so the answer is do blood cultures.
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Quote:
Originally Posted by Renaissance View Post
The double question combo of knee pain in kids.

I remember the first one was septic arthritis and so we do joint drainage or aspiration or something.

The next one i got wrong. It was the one with swelling and tenderness of the left tibial tubercle. What's the correct answer for this?

edit: just realized it could be osteomyelitis and treated by antibiotic therapy. Oh my god im such a dumbass!
first one was septic arthritis, do joint aspiration
second one was osgood-schlatter, i made the right diagnosis but i chose MRI to confirm. answer however is to treat with stretching and NSAIDS, so NSAIDs is the answer (osgood-schlatter is diagnosed clinically, no need to do further workup)
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the one with crohn's disease and signs of GI obstruction.

There's ileocecal fistula, small-bowel adhesions, small-bowel strictures, and small-bowel adhesions i think.

I pciked fistula (but im guessing it was strictures?). How come?!
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Quote:
Originally Posted by Renaissance View Post
the one with crohn's disease and signs of GI obstruction.

There's ileocecal fistula, small-bowel adhesions, small-bowel strictures, and small-bowel adhesions i think.

I pciked fistula (but im guessing it was strictures?). How come?!
lol yea i narrowed it down to strictures and fistulas, the answer is strictures (i checked in step up to step 2). makes sense.
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Quote:
Originally Posted by Dr.NickRiviera View Post
why was the answer for the 18month old kid who had a myoclonic seizure and is ok now, but high fever, a CT scan?

what does she have? initially i thought she had a febrile seizure. but she has a high temp and neck stiffness, so she has meningitis.

so then its a meningitis management question, in which case you always do lumbar puncture first THEN antibiotics (unless signs of neuro damange, then do antibiotics then CT, but seizures dont count as neuro damage right?)

i answered lumbar puncture but got it wrong
so then thought CT scan but the offline key said antibiotics.

where am i going wrong?
i thought it was a febrile seizure as well so i went ahead with LP. I just looked at MTB infectious chapter and it says that 1- papilledema 2- focal neuro deficits 3- confusion 4- SEIZURES are presentations of possible increased ICP and therefore CT should be done before LP. However, if anything should delay antibiotics then give antibiotics right away
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what was the one about the pt with a hard, cord-like structure at the site of varicose veins? it asked next step.

offline key said subcutaneous enoxaprin.

what is the diagnosis? had no idea about this one.
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Quote:
Originally Posted by Renaissance View Post
i thought it was a febrile seizure as well so i went ahead with LP. I just looked at MTB infectious chapter and it says that 1- papilledema 2- focal neuro deficits 3- confusion 4- SEIZURES are presentations of possible increased ICP and therefore CT should be done before LP. However, if anything should delay antibiotics then give antibiotics right away
damn, seizures counts as part of that criteria? i didnt know that, ugh. DIT failed me there, they didnt mention seizures.

ok that makes sense then.
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Quote:
Originally Posted by Dr.NickRiviera View Post
damn, seizures counts as part of that criteria? i didnt know that, ugh. DIT failed me there, they didnt mention seizures.

ok that makes sense then.
Its weird coz no one mentions seizures as a criteria other than MTB! I should double check that one
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Quote:
Originally Posted by Dr.NickRiviera View Post
what was the one about the pt with a hard, cord-like structure at the site of varicose veins? it asked next step.

offline key said subcutaneous enoxaprin.

what is the diagnosis? had no idea about this one.
Nope. The offline key had that one wrong. It's actually warm compresses.
The diagnosis was superficial venous thrombophlebitis (or thrombosis), and the best treatment is warm compresses
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Quote:
Originally Posted by Renaissance View Post
Nope. The offline key had that one wrong. It's actually warm compresses.
The diagnosis was superficial venous thrombophlebitis (or thrombosis), and the best initial treatment is warm compresses
what the heck is the cord-like mass?
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Quote:
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what the heck is the cord-like mass?
http://www.google.com/imgres?start=1...29&tx=43&ty=95

The varicose veins i think
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Quote:
Originally Posted by Renaissance View Post

oh, i was thinking like some bony tumor or something.
tbh, i had no idea what thromboplebitis really is. all i know is a clot forms and the vein gets inflammed. i dont know much beyond that.

i had also gotten that question with the pic of the legs are 'pruritic ulcers around the ankles' description wrong. turns out it was venous stasis. i chose the answer i had never heard of before, phlegmus dolens cutanea or whatever it was.. lol
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Guys I just took NBME 4, and got a 340 (Step score of 204). My exam is in two weeks. What do you guys think? Is two weeks enough time to raise it up??
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The one with DVT and subsequent PE after an operation of colectomy.

Which therapy do we use? I picked IVC filter becuase i thought surgery was a contraindication to all forms of anti-coagulation (so i crossed out thrombolytics and oral warfarin)
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what was the answer to the psych question bout the depressed kid who thought about suicide but wont do it cuz its against his religion and itll hurt his family.

offline key said e) tell his fam to pray with him

but i chose that and it was wrong

so maybe im thinking 'dont send him to school he cant think while like this' or maybe even 'dont let him near guns'.
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Quote:
Originally Posted by Renaissance View Post
The one with DVT and subsequent PE after an operation of colectomy.

Which therapy do we use? I picked IVC filter becuase i thought surgery was a contraindication to all forms of anti-coagulation (so i crossed out thrombolytics and oral warfarin)
was that the one where it said whats next step? and answer A was spiral CT scan, i chose that, and i got it right.
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Quote:
Originally Posted by Bobby Medicine View Post
Guys I just took NBME 4, and got a 340 (Step score of 204). My exam is in two weeks. What do you guys think? Is two weeks enough time to raise it up??
if you study 12 hrs a day, yes.

but for me (aiming for 230), if i was at 204, 2 weeks wouldnt be enough for me. but thats me, i have a slow and steady approach to study.
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Quote:
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was that the one where it said whats next step? and answer A was spiral CT scan, i chose that, and i got it right.
But I thought we were supposed to treat before any investigations!
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Quote:
Originally Posted by Dr.NickRiviera View Post
what was the answer to the psych question bout the depressed kid who thought about suicide but wont do it cuz its against his religion and itll hurt his family.

offline key said e) tell his fam to pray with him

but i chose that and it was wrong

so maybe im thinking 'dont send him to school he cant think while like this' or maybe even 'dont let him near guns'.
lol i picked that answer too. i remember i read it somewhere for step 1 that religion could be good if the guy's religious. but it was wrong so im not sure. guessing having guns near him wouldnt be such a good idea
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  #26  
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Quote:
Originally Posted by Dr.NickRiviera View Post
oh, i was thinking like some bony tumor or something.
tbh, i had no idea what thromboplebitis really is. all i know is a clot forms and the vein gets inflammed. i dont know much beyond that.

i had also gotten that question with the pic of the legs are 'pruritic ulcers around the ankles' description wrong. turns out it was venous stasis. i chose the answer i had never heard of before, phlegmus dolens cutanea or whatever it was.. lol
yup...two questions with almost the same concept
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But I thought we were supposed to treat before any investigations!

hmmm, thats true, maybe im thinking of a diff question?

i dont recall IVC filter being correct for any question doe
if heparin was an answer then thats it, which block which question # was this? ill look at it right now.
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Quote:
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hmmm, thats true, maybe im thinking of a diff question?

i dont recall IVC filter being correct for any question doe
if heparin was an answer then thats it, which block which question # was this? ill look at it right now.
i think its the same question you're talking about becuase it has spiral ct of the chest as answer A.

block 1
answers were
a) spiral ct of the chest
b) oral warfarin
c) IV tpa
d) pulmonary angiography
e) placement of IVC filter
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i think its the same question you're talking about becuase it has spiral ct of the chest as answer A.

block 1
answers were
a) spiral ct of the chest
b) oral warfarin
c) IV tpa
d) pulmonary angiography
e) placement of IVC filter
none of the other answers make sense.
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block 1

a 13 yr old boy presents with a 2 week history of left hip pain and limping.

I chose answer a) which is inflammation of synovial lining of hip joint, but it was wrong

is it leg-parthe-calve disease - answer b) avascular necrosis? How come?!
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Quote:
Originally Posted by Renaissance View Post
block 1

a 13 yr old boy presents with a 2 week history of left hip pain and limping.

I chose answer a) which is inflammation of synovial lining of hip joint, but it was wrong

is it leg-parthe-calve disease - answer b) avascular necrosis? How come?!
slipped capital epi

answer was something about the epiphysial growth plate, they worded it all scientifically to confuse you. it was like C or D.
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slipped capital epi

answer was something about the epiphysial growth plate, they worded it all scientifically to confuse you. it was like C or D.
I had no clue
and 95th percentile weight too
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I had no clue
and 95th percentile weight too
easy question man, textbook case.
fat little kid with hip pain and a limp.
you know thats gota be slipped capital epi
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Quote:
Originally Posted by Dr.NickRiviera View Post
easy question man, textbook case.
fat little kid with hip pain and a limp.
you know thats gota be slipped capital epi
true true...their wording confused me i guess
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true true...their wording confused me i guess
yea they got you on wording there.
i had to take a minute to reread the options to understand what each one was really explaining.
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http://nbmeanswerkeys.blogspot.com/2...ne-answer.html
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  #37  
Old 08-09-2013
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Hey.. Hv u taken form 6 yet? Can u share ans key for form 6 if u hv one? Pls..
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A 22 year old with recurrect asthma like attack like 6 times in half a year . She works in jewellary factory. Symptoms are worse in Spring and fall. Now she feels fine, she takes albuterol , what will reduce the recurrrent attack?

A) Change in work environment
B) Desensitization to animal dander
C) Fluticasone inhaler therapy
E) Influenza vaccine
F) 23 valent pneumococcal vaccine

can anybody answer the question
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Old 08-15-2013
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A 22 year old with recurrect asthma like attack like 6 times in half a year . She works in jewellary factory. Symptoms are worse in Spring and fall. Now she feels fine, she takes albuterol , what will reduce the recurrrent attack?

A) Change in work environment
B) Desensitization to animal dander
C) Fluticasone inhaler therapy
E) Influenza vaccine
F) 23 valent pneumococcal vaccine

can anybody answer the question
what was the answer? i think i put E but i think that was wrong.
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Quote:
Originally Posted by polok15 View Post
A 22 year old with recurrect asthma like attack like 6 times in half a year . She works in jewellary factory. Symptoms are worse in Spring and fall. Now she feels fine, she takes albuterol , what will reduce the recurrrent attack?

A) Change in work environment
B) Desensitization to animal dander
C) Fluticasone inhaler therapy
E) Influenza vaccine
F) 23 valent pneumococcal vaccine

can anybody answer the question
I put A and that was wrong
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Old 08-15-2013
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I think it's fluticasone inhaler
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  #42  
Old 08-18-2013
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Quote:
Originally Posted by Dr.NickRiviera View Post
hmmm, thats true, maybe im thinking of a diff question?

i dont recall IVC filter being correct for any question doe
if heparin was an answer then thats it, which block which question # was this? ill look at it right now.
The patient was on heparin in the question stem. Missed that one
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Old 11-02-2013
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the one with 2 year old girl brought to emergency after seizures...erythematous bulging right tm...it could hv been a brain abscess..spread of infection...
so i chose ct on it...
is it just febrile seizures?
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Old 11-02-2013
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and what about the one with hrt and hazard ratio...i chose no conclusion because no p value was provided...u dont know if the study reached statistical significance..
or is it because the 95 percent confidence interval were above 1..so i dont need to look at p value to judge the outcome of the study??
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  #45  
Old 12-20-2013
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Default How difficult?

I still haven't done nbme 4.. I've got 10 days left on my exam, how difficult is it ??
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