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  #1  
Old 09-06-2013
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Arrow NBME 6 discussion

If anyone wants to discuss...

Post whatever question you might have
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  #2  
Old 09-06-2013
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Does anyone remember the one with the media murmur of a kid with URTI?
I think the answers were:
A- URTI
B- VSD
C- pericarditis
D- CHF
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Old 09-06-2013
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Also, one question from Ob/Gyn was really annoying.

A couple presenting with inability to concieve and the 30-something year-old wife has a lot of acne and normal hormones (LH, FSH, Testerone).

Answers if I remember correctly were:
Endometriosis
PCOS
Premature ovarian failure
Turner's
Hyperprolactinoma
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  #4  
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I got both of them wrong too. The media player did not work on the first one and i randomly pick VSD. It wasn't the right answer. And the second one. Its obviously not pcos or turners, so may be premature ovarian failure ? although it doesn't make sense.
BTW how many did you get wrong renaissance ?
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15 y/o f not compliant with asthmatic medications, what do you do ?

Is it write a contract? the other options were reward & punish , refuse to see , recommend psych evaluation , clonidine , fluoxetene , methyl phenidate ?
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  #6  
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Also 25 y/o unhappy cause she is unable to find a mate. Men date and terminate relationship with her. calls and secretly follows her ex-bfs. well healed superficial lacerations on the wrist. Dx?

adjustment , borderline PD , delusional , gender identity , MDD .
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Quote:
Originally Posted by asclepius View Post
I got both of them wrong too. The media player did not work on the first one and i randomly pick VSD. It wasn't the right answer. And the second one. Its obviously not pcos or turners, so may be premature ovarian failure ? although it doesn't make sense.
BTW how many did you get wrong renaissance ?
Lol I picked VSD and premature ovarian failure as well. Both were wrong. I don't know about the murmur one, but the Ob/gyn is probably endometriosis for some reason
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Quote:
Originally Posted by asclepius View Post
Also 25 y/o unhappy cause she is unable to find a mate. Men date and terminate relationship with her. calls and secretly follows her ex-bfs. well healed superficial lacerations on the wrist. Dx?

adjustment , borderline PD , delusional , gender identity , MDD .
Definitely borderline. At least that's what I remember putting it.

Hint from step 1: borderline personality disorder -self mutilation and unstable relationships. (Tif you've seen it, think glen close from the movie fatal attraction)
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  #9  
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Quote:
Originally Posted by asclepius View Post
15 y/o f not compliant with asthmatic medications, what do you do ?

Is it write a contract? the other options were reward & punish , refuse to see , recommend psych evaluation , clonidine , fluoxetene , methyl phenidate ?
This question is completely ****ed up. I chose the answer with -reward and punish- and it was wrong. None of the other choices make sense though
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Quote:
Originally Posted by asclepius View Post
BTW how many did you get wrong renaissance ?
NBME score 450
Step 2 3-digit score 227

Block 1: 10 questions wrong
Block 2: 5 questions wrong
Block 3: 10 questions wrong
Block 4: 8 questions wrong

Overall: 33 questions wrong. Meaning 82%
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  #11  
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What about the question with a non-compaint schizophrenic patient.

In non compliant patients the usual course of action is to give a long acting neuroleptic.
Mainly Rosperidone, haloperidol, or fluphenazine.
The only problem? All were mentioned in the choices!

I picked Rosperidone and got it wrong.

EDIT:
Long acting injectable neuroleptics for non-compliant patients are:
Risoeridone DEPOT
Fluphenazine DECANOATE
Haloperidol DECANOATE

That played with the choices. Tricky question.

Last edited by Renaissance; 09-07-2013 at 06:08 AM.
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Thanks.Yeah Borderline makes sense.. I was not sure cause usually you have the perception of extremes where everyone is either very good or extremely bad. Thanks for the tip. And Endometriosis might be right too. Normal hormones makes PCOS, turners, pof and prolactinoma all not possible. but acne ??
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MTB mentions if i am not wrong Haloperidol decanoate depot injections are very specifically given to non complaint patients. Thats what i picked and it was correct. You are write though fluphenazine is also long acting. But i think Risperidone cannot be correct cause the patient had more positive symptoms and typicals would be preferred.
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Quote:
Originally Posted by Renaissance View Post
Also, one question from Ob/Gyn was really annoying.

A couple presenting with inability to concieve and the 30-something year-old wife has a lot of acne and normal hormones (LH, FSH, Testerone).

Answers if I remember correctly were:
Endometriosis
PCOS
Premature ovarian failure
Turner's
Hyperprolactinoma
it is endometriosis for sure, cause all the choices will be abnormal hormone test
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Quote:
Originally Posted by polok15 View Post
it is endometriosis for sure, cause all the choices will be abnormal hormone test
My thoughts exactly.
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  #16  
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The one with the kid that has otitis media and is given antibiotics and it isn't going away.

Choices were:
Tympanocentsis
CT head

I picked tympanocentesis which was wrong. I remember MTB saying "tympanocentesis is done in kids with OM who don't respond to antibiotic therapy"

The answer is CT head I guess? Due to spread of infection and subsequent mastoiditis?
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Quote:
Originally Posted by Renaissance View Post
The one with the kid that has otitis media and is given antibiotics and it isn't going away.

Choices were:
Tympanocentsis
CT head

I picked tympanocentesis which was wrong. I remember MTB saying "tympanocentesis is done in kids with OM who don't respond to antibiotic therapy"

The answer is CT head I guess? Due to spread of infection and subsequent mastoiditis?
Yes CT is next in case of mastoiditis(outward and downward displaced pinna)
If CT shows no destruction of mastoid air cells then do myringotomy + IV antibiotics
If CT shows destruction of mastoid air cells then to Mastoidectomy + IV antibiotics.
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  #18  
Old 09-08-2013
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Ob/Gyn question

Female patient having sex with her husband and the condom broke.
LMP 2 weeks ago
Urine pregnancy test negative

Post-coital contraception?:
-D&C immediately
-Levonorgestrel now and 12 hours later
-Prostaglandin f2 now and 12 hours later
-intravaginal spermaticide

I answered prostaglandin f2 which was wrong

What's the concept they're looking for in this question?!
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There's the one where a patient comes in for a routine examination. He explains to the doctor he wants to get in shape and wants to start on a vigorous exercise program. What tests should be done?:

- exercise stress test
- spirometry
- cath
- CBC
- homocysteine levels

I picked spirometry because he was a heavy smoker. It was wrong.

Guessing exercise stress test? How come?!
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Quote:
Originally Posted by Renaissance View Post
Ob/Gyn question

Female patient having sex with her husband and the condom broke.
LMP 2 weeks ago
Urine pregnancy test negative

Post-coital contraception?:
-D&C immediately
-Levonorgestrel now and 12 hours later
-Prostaglandin f2 now and 12 hours later
-intravaginal spermaticide

I answered prostaglandin f2 which was wrong

What's the concept they're looking for in this question?!
it looks like the woman had sex at the time of ovulation

levorgestrol will help

prostaglandin is an abortificient
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Quote:
Originally Posted by Renaissance View Post
There's the one where a patient comes in for a routine examination. He explains to the doctor he wants to get in shape and wants to start on a vigorous exercise program. What tests should be done?:

- exercise stress test
- spirometry
- cath
- CBC
- homocysteine levels

I picked spirometry because he was a heavy smoker. It was wrong.

Guessing exercise stress test? How come?!
if the patient is otherwise healthy normal physical exam
then cbc is done in routine physical
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I am not 100 percent sure with those answers , just shared what I felt right please other give their opinion too
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Quote:
Originally Posted by Renaissance View Post
There's the one where a patient comes in for a routine examination. He explains to the doctor he wants to get in shape and wants to start on a vigorous exercise program. What tests should be done?:

- exercise stress test
- spirometry
- cath
- CBC
- homocysteine levels

I picked spirometry because he was a heavy smoker. It was wrong.

Guessing exercise stress test? How come?!
Was he diabetic?
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Quote:
Originally Posted by Renaissance View Post
There's the one where a patient comes in for a routine examination. He explains to the doctor he wants to get in shape and wants to start on a vigorous exercise program. What tests should be done?:

- exercise stress test
- spirometry
- cath
- CBC
- homocysteine levels

I picked spirometry because he was a heavy smoker. It was wrong.

Guessing exercise stress test? How come?!
I guess patient was more than 45 years old.So answer would be exercise stress test.

American Heart Association recommend
exercise treadmill testing for
asymptomatic patients with diabetes mellitus,
men older than 45 years of age, and
women older than 55
years of age before they undertake vigorous
exercise
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  #25  
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if they put age and diabetis two other risk factors for coronary artery diseases then ETT may be right.
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can somebody explain that one with woman with forgetfulness and also abnormal movements of tongue etc.
i answered wilson dis?
the ans in offline answers seems to be wrong
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Quote:
Originally Posted by rg99 View Post
can somebody explain that one with woman with forgetfulness and also abnormal movements of tongue etc.
i answered wilson dis?
the ans in offline answers seems to be wrong
That's Huntington's. I got that right.
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Old 09-18-2013
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Quote:
Originally Posted by Renaissance View Post
Lol I picked VSD and premature ovarian failure as well. Both were wrong. I don't know about the murmur one, but the Ob/gyn is probably endometriosis for some reason
The media question was just a URI. I didn't really hear a murmur. Although on other forums online a few people claim to have heard a flow murmur although I'm skeptical about that. URI is right though.
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  #29  
Old 09-18-2013
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On another note, was anyone else really disappointed with the NBME 6 questions. It didn't seem as hard as I was expecting, especially considering how everyone says the actual exam was a killer. Most questions seemed extremely straight forward.
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Old 09-19-2013
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Couple of doubts from NBME 6 of my own.

1) The question about a 15 year old kid in a motor vehicle accident being hypotensive with normal neck veins having dullness to percussion and decreased breath sounds. I know the answer was hemothorax and i got it right. But there was an option of diaphragmatic rupture, and my question is without an xray how could they expect you to answer hemothorax right away? Is there something im missing?

2) The one with a 24 year old having sudden onset breathlessness and chest pain on the right side with normal vitals and showing a chest x ray with what appeared to be a right lower lobe air pocket of some sort? (correct me if i'm wrong/rephrase my xray description), so i chose tube thoracostomy, and it was right. So was the diagnosis a ruptured bleb of some kind causing a pneumothorax? I wasnt very sure.

3) The one with a 82 year old female having increasing forgetfulness, memory lapses, decreased sleep and appetite with history of similar symptoms 2 and and 5 years ago treated with medication. I chose multi infarct dementia thinking that the exact time line of previous occurences was a giveaway. Turns out i was wrong. What was the answer then? Major depression (pseudodementia)? I ruled that one out because she was brought it by the daughter. But now maybe.......

Thats it for now. I'll update more doubts if needed as i go more of the questions.

Everyone who has gone through NBME 6 please participate and make it a discussion! Contribute and help out people with their doubts and ask doubts of your own and see if others can help you out too
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  #31  
Old 09-19-2013
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The one about a 72 year old man with chronic abdominal pain and headaches. The guy drinking homemade alcohol. What was the diagnosis and answer for that? I choose porphobilinogen levels but that was wrong!

Edit- Upon a tip from a friend, i was looking it up on Google, and apparently moonshine can have some lead content in them due to some contamination from the manufacturing process!

Last edited by rohit39; 09-19-2013 at 02:47 AM.
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Old 09-19-2013
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The one where a lady as bloating, crampy pain and intermittent diarrhea for 5 years thats been exacerbated by starting a yoghurt and cottage cheese rich diet? I stupidly chose secretory diarrhea thinking lactose intolerance, but on retrospect i realise that A) Lactose intolerance isnt really precipitated by curd or cottage cheese (i looked it up) and B) Lactose intolerance is osmotic diarrhea, not secretory diarrhea! (D'oh!). So what IS the answer?!
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  #33  
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Quote:
Originally Posted by rohit39 View Post
The one where a lady as bloating, crampy pain and intermittent diarrhea for 5 years thats been exacerbated by starting a yoghurt and cottage cheese rich diet? I stupidly chose secretory diarrhea thinking lactose intolerance, but on retrospect i realise that A) Lactose intolerance isnt really precipitated by curd or cottage cheese (i looked it up) and B) Lactose intolerance is osmotic diarrhea, not secretory diarrhea! (D'oh!). So what IS the answer?!
yea i made this same mistake...dont know the ans.

and the 3. q is pseudodementia, all features of Major depression were listed in the q. Anyway but i also got it wrong
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  #34  
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i read somewhere on forum dat yoghurt q. - irritable bowel syndrome
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Hi all I thought I'd clarify a few things - I did the exam online through NBME and paid for the extra feedback.

For the OBGYN question, endometriosis is wrong (I picked it) and hyperprolactinemia is wrong too (my friend picked that). Therefore the only choice left is PCOS I guess. I can't explain why testosterone and DHEAS are normal. I thought it was hyperprolactinema when I reviewed it because it does cause acne and prolonged periods but I guess that's wrong too. This is just a brutal question meant to confuse the heck out of everyone.

The 15 year old writing a contract is correct. It gives them responsibility and makes them accountable for their actions which is the way to go for an adolescent.

Stress test is correct for the guy wanting to start the exercise program.

3) The one with a 82 year old female having increasing forgetfulness, memory lapses, decreased sleep and appetite with history of similar symptoms 2 and and 5 years ago treated with medication. I chose multi infarct dementia thinking that the exact time line of previous occurences was a giveaway. Turns out i was wrong. What was the answer then? Major depression (pseudodementia)? I ruled that one out because she was brought it by the daughter. But now maybe.......

I'm pretty sure it's depression based on everything I could find on google. I picked Alzheimers for it which was completely stupid of me since Alzheimers can't be instantly treated 2x and is progressive. Turns out half of the people on google still think it's Alzheimers but it's definitely wrong.

The one where a lady as bloating, crampy pain and intermittent diarrhea for 5 years thats been exacerbated by starting a yoghurt and cottage cheese rich diet? I stupidly chose secretory diarrhea thinking lactose intolerance, but on retrospect i realise that A) Lactose intolerance isnt really precipitated by curd or cottage cheese (i looked it up) and B) Lactose intolerance is osmotic diarrhea, not secretory diarrhea! (D'oh!). So what IS the answer?!

I picked secretory too haha...obviously wrong. If you look on various sources, some say that lactose tolerance isn't exacerbated by those items, but they clearly contain lactose and her symptoms match those to lactose intolerance so malabsorption is most likely right...this one I can't confirm though other than just telling you that secretory is wrong (which you already knew)
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  #36  
Old 09-20-2013
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Quote:
Originally Posted by of4l View Post
Hi all I thought I'd clarify a few things - I did the exam online through NBME and paid for the extra feedback.

For the OBGYN question, endometriosis is wrong (I picked it) and hyperprolactinemia is wrong too (my friend picked that). Therefore the only choice left is PCOS I guess. I can't explain why testosterone and DHEAS are normal. I thought it was hyperprolactinema when I reviewed it because it does cause acne and prolonged periods but I guess that's wrong too. This is just a brutal question meant to confuse the heck out of everyone.

The 15 year old writing a contract is correct. It gives them responsibility and makes them accountable for their actions which is the way to go for an adolescent.

Stress test is correct for the guy wanting to start the exercise program.

3) The one with a 82 year old female having increasing forgetfulness, memory lapses, decreased sleep and appetite with history of similar symptoms 2 and and 5 years ago treated with medication. I chose multi infarct dementia thinking that the exact time line of previous occurences was a giveaway. Turns out i was wrong. What was the answer then? Major depression (pseudodementia)? I ruled that one out because she was brought it by the daughter. But now maybe.......

I'm pretty sure it's depression based on everything I could find on google. I picked Alzheimers for it which was completely stupid of me since Alzheimers can't be instantly treated 2x and is progressive. Turns out half of the people on google still think it's Alzheimers but it's definitely wrong.

The one where a lady as bloating, crampy pain and intermittent diarrhea for 5 years thats been exacerbated by starting a yoghurt and cottage cheese rich diet? I stupidly chose secretory diarrhea thinking lactose intolerance, but on retrospect i realise that A) Lactose intolerance isnt really precipitated by curd or cottage cheese (i looked it up) and B) Lactose intolerance is osmotic diarrhea, not secretory diarrhea! (D'oh!). So what IS the answer?!

I picked secretory too haha...obviously wrong. If you look on various sources, some say that lactose tolerance isn't exacerbated by those items, but they clearly contain lactose and her symptoms match those to lactose intolerance so malabsorption is most likely right...this one I can't confirm though other than just telling you that secretory is wrong (which you already knew)
I did the question offline and picked malabsorption, I never felt at first it was lactose intolerance, lactose intolerance shouldnot cause abdominal pain
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  #37  
Old 09-20-2013
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Hi I just did it and also chose the extended feedback.
yes I chose hyperprolactinemia and it is wrong,and I am wondering what is the correct answer bz the Q mentioned her menses are not painful and all hormones are normal.
for the lady with dementia yes the correct answer is major depression she fullfilled 5 criteria.
for the Q about the lady who started yoghurt and cottage cheese I picked malabsorption and I was thinking about lactose intolerance also :def of lactase will cause malabsorption and accumulation of lactose hence osmotic diarrhea, as u said some ppl say these types of food do not cause lactose intolerance ,anyhow malabsorption is the correct answer.
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  #38  
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I need some answers plz
!-the Q about the appropriate analgesia for moderate sever pain post total hysterectomy.
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Old 09-20-2013
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Originally Posted by sonami View Post
I need some answers plz
!-the Q about the appropriate analgesia for moderate sever pain post total hysterectomy.
Morphine PCA
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  #40  
Old 09-20-2013
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Quote:
Originally Posted by rohit39 View Post
Couple of doubts from NBME 6 of my own.

1) The question about a 15 year old kid in a motor vehicle accident being hypotensive with normal neck veins having dullness to percussion and decreased breath sounds. I know the answer was hemothorax and i got it right. But there was an option of diaphragmatic rupture, and my question is without an xray how could they expect you to answer hemothorax right away? Is there something im missing?

2) The one with a 24 year old having sudden onset breathlessness and chest pain on the right side with normal vitals and showing a chest x ray with what appeared to be a right lower lobe air pocket of some sort? (correct me if i'm wrong/rephrase my xray description), so i chose tube thoracostomy, and it was right. So was the diagnosis a ruptured bleb of some kind causing a pneumothorax? I wasnt very sure.

3) The one with a 82 year old female having increasing forgetfulness, memory lapses, decreased sleep and appetite with history of similar symptoms 2 and and 5 years ago treated with medication. I chose multi infarct dementia thinking that the exact time line of previous occurences was a giveaway. Turns out i was wrong. What was the answer then? Major depression (pseudodementia)? I ruled that one out because she was brought it by the daughter. But now maybe.......

Thats it for now. I'll update more doubts if needed as i go more of the questions.

Everyone who has gone through NBME 6 please participate and make it a discussion! Contribute and help out people with their doubts and ask doubts of your own and see if others can help you out too

see in the hemothorax q , they also said the patient was very hypotensive and diapharagmatic rupture presentation would be different like u can hear bowel sound in lung field

it is tube thoracostomy and case primary spontaneouse pneumothorax
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  #41  
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Quote:
Originally Posted by sonami View Post
Hi I just did it and also chose the extended feedback.
yes I chose hyperprolactinemia and it is wrong,and I am wondering what is the correct answer bz the Q mentioned her menses are not painful and all hormones are normal.
for the lady with dementia yes the correct answer is major depression she fullfilled 5 criteria.
for the Q about the lady who started yoghurt and cottage cheese I picked malabsorption and I was thinking about lactose intolerance also :def of lactase will cause malabsorption and accumulation of lactose hence osmotic diarrhea, as u said some ppl say these types of food do not cause lactose intolerance ,anyhow malabsorption is the correct answer.
I am so sad ,, because people indeed lie in forums , See , I discussed this q with a girl in forum who took the nbme 6 , extended version , she said it was lactose intolerance, In MTB 2 ck , it cleary said cottage cheese , yougurt actually make lactose intolerance better.I spent so much time to research it to make the answr lactose intolerance, but I failed each time
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Quote:
Originally Posted by rohit39 View Post
The one about a 72 year old man with chronic abdominal pain and headaches. The guy drinking homemade alcohol. What was the diagnosis and answer for that? I choose porphobilinogen levels but that was wrong!

Edit- Upon a tip from a friend, i was looking it up on Google, and apparently moonshine can have some lead content in them due to some contamination from the manufacturing process!
this guy has microcytic anemia, so lead poisoning / siderblastic is the answer.

porphyria is a genetic diseases isn't it
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  #43  
Old 09-20-2013
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I am so sad ,, because people indeed lie in forums , See , I discussed this q with a girl in forum who took the nbme 6 , extended version , she said it was lactose intolerance, In MTB 2 ck , it cleary said cottage cheese , yougurt actually make lactose intolerance better.I spent so much time to research it to make the answr lactose intolerance, but I failed each time
but lactose intolerance per se was not in the answer choices anyhow the correct answer is malabsorption what is the correct explanation I have no idea
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Quote:
Originally Posted by sonami View Post
but lactose intolerance per se was not in the answer choices anyhow the correct answer is malabsorption what is the correct explanation I have no idea
sorry secretory diarrhea
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Quote:
Originally Posted by sonami View Post
Hi I just did it and also chose the extended feedback.
yes I chose hyperprolactinemia and it is wrong,and I am wondering what is the correct answer bz the Q mentioned her menses are not painful and all hormones are normal.
for the lady with dementia yes the correct answer is major depression she fullfilled 5 criteria.
for the Q about the lady who started yoghurt and cottage cheese I picked malabsorption and I was thinking about lactose intolerance also :def of lactase will cause malabsorption and accumulation of lactose hence osmotic diarrhea, as u said some ppl say these types of food do not cause lactose intolerance ,anyhow malabsorption is the correct answer.
menses are not painful, that most likely it was pcos,

did they give LH and FSH,

LH:FSH=2:1

it is PCOS
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Quote:
Originally Posted by polok15 View Post
menses are not painful, that most likely it was pcos,

did they give LH and FSH,

LH:FSH=2:1

it is PCOS
If I recall correctly they did not give LH and FSH values. Or if they did it wasn't in a 2:1 ratio definitely. I ended up picking PCOS anyway but only because the other options made less sense to me at the time! (Dumb luck).
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Quote:
Originally Posted by sonami View Post
Hi I just did it and also chose the extended feedback.
yes I chose hyperprolactinemia and it is wrong,and I am wondering what is the correct answer bz the Q mentioned her menses are not painful and all hormones are normal.
for the lady with dementia yes the correct answer is major depression she fullfilled 5 criteria.
for the Q about the lady who started yoghurt and cottage cheese I picked malabsorption and I was thinking about lactose intolerance also :def of lactase will cause malabsorption and accumulation of lactose hence osmotic diarrhea, as u said some ppl say these types of food do not cause lactose intolerance ,anyhow malabsorption is the correct answer.
Thanks Sonami. Cleared a major doubt for me!
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Originally Posted by rohit39 View Post
Thanks Sonami. Cleared a major doubt for me!
you are welcome , thank u too for answering the Q about infertility it is a weird one bz they mentioned FSH, LH, DHEAS, testesterone ,TSH all are normal.
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  #49  
Old 10-14-2013
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Default nbme 6

Hi does anyone have offline version of nbme 6..jsut took it online and had to review it now...can u plz email it to me at troponin01@gmail.com


would really appreciate your time!!
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Old 10-14-2013
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pls post your queries
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  #51  
Old 10-15-2013
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62-year-old man has not had any urine output since the Foley catheter was removed 12 hours ago, post laparascopic cholecystectomy.

One hour after receiving an intravenous bolus of 0.9% saline, the patient does not produce any urine. Which of the following is the most appropriate next step in management?

A) Increase in the dose of morphine

B) Intravenous administration of an additional bolus of 0.9% saline

C) Intravenous administration of doxazosin

D) Intravenous administration of furosemide

E) Reinsertion of a Foley catheter

Any idea, I chose D and was wrong. Thinking it should be reinsertion of foley
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  #52  
Old 10-15-2013
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reinsertion of floey might be the answer , cause , because there is still bladder atony
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Old 10-25-2013
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Quote:
Originally Posted by rg99 View Post
yea i made this same mistake...dont know the ans.

and the 3. q is pseudodementia, all features of Major depression were listed in the q. Anyway but i also got it wrong
Bloating (also can mention : foul smell /large volume /unable to flush /floating) ---> malabsorption
cheese ( fat ) ----> fat malabsortion
also i think they mentioned that fecal fat was +ve can't remember
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Old 10-25-2013
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Default A couple presenting with inability to concieve

A couple presenting with inability to concieve and the 30-something year-old wife has a lot of acne and normal hormones (LH, FSH, Testerone).

NOT Endometriosis ( no dysparunia, dyschezia, no cyclic pain)
NOT Premature ovarian failure(no symps of menopause ; flushing ,irritability..etc)
NOT Turner's ( no Amenorrhea , no charactaristic features )
NOT Hyperprolactinoma ( must be amenorrhea -not just dysmenorrhea- no galactorrhea , FSH and LH MUST be low)

it's PCOS
because LH/FSH RATIO >2:1 is the diagnostic tool
FSH might be still in low normal
LH might be still in high normal
DHEAS is not specific ( it might be N/increased) ..very high in adrenal
testosterone not specific for PCOS ( N/increased) .. very high in ovarian tumor ) and both DHEAS and testosterone cause hirsutism PLUS virilization with is absent here

the problem in this question is that in less than 1 min to answer ... you forget the exceptions and the other possiblities and only remember the typical presentation ...too bad !
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  #55  
Old 11-11-2013
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what about the one with a female who had laparoscopic cholecystectomy 2 months ago..had jaundice...alp was raised,total and direct billirubin was raised...
usg showed..dilation of intrahepatic billary ducts..most apt next step?
a)ct scan
b)ercp
c)hida
d)surgical exploration
e)i/v anibiotics.
is the answer ercp?
i chose ct..
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Old 11-12-2013
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Quote:
Originally Posted by drsrb View Post
what about the one with a female who had laparoscopic cholecystectomy 2 months ago..had jaundice...alp was raised,total and direct billirubin was raised...
usg showed..dilation of intrahepatic billary ducts..most apt next step?
a)ct scan
b)ercp
c)hida
d)surgical exploration
e)i/v anibiotics.
is the answer ercp?
i chose ct..
"dilated IH bile duct(or even CBD) and no stone found on US" what's next ?
Hx of cholecystectomy (as in this case): you have 3 options--->
functional pain : excluded by seeing dilated ducts on US and increased ALP
the other 2 are Sphincter dysfunction vs CBD stone not visible on US
NEXT is ERCP or Endoscopic US to differentiate both and to do sphincterotomy in the former and stone removal in the latter

Hx suggesting pancreatic cancer ( middle - old age / smoking / chronic pancreatitis / vague discomfort / weight loss : CT abdomen

NB : HIDA scan only used when suspecting acute cholecystits with normal US

hope this helps
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Old 11-13-2013
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Hey guys , did anyone get the question about 6 month old child brought in for poor feeding an recurrent respiratory tract infections since birth. Examination showing to and fro murmur in the second left intercostal space, loud S2, bounding pulses and widened pulse pressure. The question asked for the most likely diagnosis.
a)ASD ( secundum type) b) ASD (primum type) c)atrio ventricuar canal d) coartctation of the aorta e) Hypolastic left heart f)PDA g) Tetralogy of Fallot h) transposition of the great vessels i) tricuspid atresia j)VSD

i was almost sure based on the presentation that the answer was truncus arterious ( with the recurrent lung infections and all) but with these answer choices, I'm just not sure. can anyone shed some light on this for me please.
thanks much!!!
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Old 11-16-2013
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yea that was pda..to-fro murmur..bounding pulses,widened pp..recurent respi infections...
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Old 11-23-2013
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Hey guys..can u plz answer these questions..

1. A 15y old girl with h/o asthma,not compliant wit medications is hospitalised 3 times in the past for acute exacerbation wit most recent 3months back.when asked,she says that she sometimes forgets to take medication and doesnt believe that she needs it.what is the most appropriate next step to make this patient compliant with her medication regimen?
a. reward/punishment by parents
b.negotiate a contract
c.refuse to see patient is noncompliant
d.begin clonidine
e.begin fluoxetine
f.begin methylphenidate
g.pychiatric evaluation




2. A 13 year old girl with normal menstral cycle every month (menarche 10months ago) tanner stage 3, not sexually active, LMP 1week ago,no further abnormalities.what is the most appropriate step in mgmt?
a. discussion of pregnancy prevention
b. measure FSH & LH
c. Urine beta HCG
d.pelvic examination
e. estrogen therapy
f. diagnostic laproscopy
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Old 11-25-2013
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1)

may be she need a psychiatry evaluation


2)Discussion of pregnancy prevention

not sure , other people who did the test can post
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Old 11-25-2013
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1)negotiate a contract...placing more responsibility on the teenage pt..there is a similar q in kaplan qbook...
2)its discussion of pregnancy prevention.
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  #62  
Old 11-28-2013
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Hey guys what about the q about the woman post cesarean section with tenderness on deep palpation on medial and lateral sides of her abdominal wound i chose wound u/s is it reassurance?
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Old 11-28-2013
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Quote:
Originally Posted by Renaissance View Post
Lol I picked VSD and premature ovarian failure as well. Both were wrong. I don't know about the murmur one, but the Ob/gyn is probably endometriosis for some reason
its endometriosis. Its cant be premature ovarian cause fsh normal.. Premature ovarian syndrome has high fsh like to menopause voman. MCC of infertility its endometriosis
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Old 11-28-2013
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Post cs one was post partum Hemorrhage... There was a drop in hct and I think if I remember correctly wound margins were normal..
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Old 11-28-2013
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Quote:
Originally Posted by drsrb View Post
Post cs one was post partum Hemorrhage... There was a drop in hct and I think if I remember correctly wound margins were normal..
The Q says: 4 weeks after a low transverse CS delivery for cephalopelvic disproportion a 27 year old woman G1P1 comes cuz a pulling feeling on the right side of her incision for the past 4 days the feeling is exacerbated with movement . she was discharged on postop day 3. within the past 2 weeks she has initiated an exercise regimen to get back into shape and has resumed sexual activity. She has been breast feeding and plans are to continue another month. She is 168cm tall and weighs 82kg bmi 29kg/m2. temp 37. there is mild tenderness to deep palpation just lateral to the right and left aspects of the abdominal incision. the surgical wound is clean, dry and intact. uterus contender. most appropriate management?

1.reassurance
2.discontinuation of breast feeding
3.U/S of the incision site (I chose this it was wrong)
4.MRI of pelvis
5.IV heparin
6.Oral broad spectrum antibiotic therapy
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7 year old girl fever and sore throat for one day. temp 38.6. exam: eythematous pharynx and slightly enlarged tonsils without exudate. no cx lymphadenopathy. rapid strep test negative. which following most app next step?
1.monospot test
2.throat culture
3.IM penicillin
4.Oral erythromycin (Chose this one, wrong)
5.Oral penicillin
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and what about the one with the boy who has a cat at home and who played in the wooded area and the q has a picture of his rash and it asks whats the recommendation to prevent the rash? is it:
1.avoidance of the wooded are
2.thorough washing after playing with the cat
3.prophylaxis with an antibacterial agent
4.prophylaxis with topical corticosteroid
5.prophylaxis with oral antihistamine
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Old 11-29-2013
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yea for that one its reassurance..
with the sore throat one u hv to get throat culture coz rapid strep test is specific but not sensitive and the presentation looks like strep pharyngitis so u hv to do culture to rule out..
and for d pik with rash,,,that was contact dermatitis..so avoidance of d wooded area..
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Thanks alot!
I've got a few more questions pls:

1.67 year old woman intubated 1 week after lobectomy for lung cancer. she has copd. prep fvc 40% of predicted. she is awake and alert. her BP is 130/75 pulse 72. ventilator settings are a synchronized intermittent mandatory ventilation of 8/min Fio2 40% and PEEP 5cmwater. ABG:
pH 7.42
PCO2 47
PO2 90
O2 sat 96%

Which is most app?
a. Antibiotic
b, Bronchodilator
c. chest physiotherapy
d. decrease inotropes
e.diuretics
f.fiberoptic bronchoscopy
g. heparin
h.incentive spirometry
i. increase fio2
j. increase inotropes
k. increase reps rate (I chose it, wrong)
l. placement of thoracostomy tube
m. tracheostomy
n. wean from ventilator

2. 4 days status post resection sigmoid cancer and colostomy, temp 39.3. CVC was inserted into left subclavian vein during procedure. pulse 94 reps 20 bp 128/70. blood cultures grow staph aureus. which is the source of the bacteria?
a.central venos catheter
b. intraabdominal abscess
c.lungs
d.operative wound (chose it, wrong)
e.urinary tract

3. 17 yo head injury, loses consciousness after driving into a freshwater lake from a platform. after being submerged for 3 mins he is rescued. he is initially cyanotic but then begins to cough and breathe spontaneously after a 5 minute resuscitation. over the next 36 hours which of the following complications is most likely?
a.ARDS
b.Bacteremia
c.Bacterial pneumona
d.Hypernatremia
e.Metabolic alkalosis


4.the 32 yo plumber who has a 3 week history of constant dull low back pain that doesn't radiate to extremities it began after unloading heave equipment from van. it increases with activity and is temporarily relieved by bed rest and ibuprofen pain increases with forward or lateral movements of the spine straight leg raising test does not increase pain absent babiniski. is it
a.herniated disc
b.lumbar spinal stenosis
c.metastatic cancer
d.muscle strain
e.osteoporotic compression fracture
f.sacroiliitis
f.spinal epidural abscess
h.spondylolisthesis

5. 67 yo 3 month history of right leg pain after walking 2 blocks and there was a table of his ll pulses with absent dorsalis pedis and posterior tibial pulses on right leg. ABI 0.6 on right
in addition to smoking cessation which is most app next step in mgmt?
a.daily exercise program
b.angioplasty (chose this, wrong)
c.arteriography
d.femeropopliteal bypass grafting
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Old 11-30-2013
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Quote:
Originally Posted by mnos7i View Post
7 year old girl fever and sore throat for one day. temp 38.6. exam: eythematous pharynx and slightly enlarged tonsils without exudate. no cx lymphadenopathy. rapid strep test negative. which following most app next step?
1.monospot test
2.throat culture
3.IM penicillin
4.Oral erythromycin (Chose this one, wrong)
5.Oral penicillin
throat culture is the answer , cause no exudate. its viral pharyngitis. its not EPB either cause no lymadenopathy
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Old 12-15-2013
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mnos7i

1.n
2.a
3.a
4.d
5 also chose b and got it wrong
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  #72  
Old 12-15-2013
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A couple I got wrong if anyone can help
1)Primigravid who gave birth to stillborn at 38 weeks
Most appropriate course of action
a) notify hospital liability dep
b)obtain consent for organ transplant
c)recomend autopsy
d)tell mother not to worry she can get pregnant again (One i chose)
e)tell the parents theres a 1 in 4 chance of it recurring

2) 70 year old man, urinary hesitancy and freq. Temp is 37.5. No urethral discharge. Rubbery,enlarged, non tender prostate. G- rods, no RBCes, many WBCes
a)infection of epididymis
b)infection of the prostate
c)infection of the urethra (one i chose)
d)neurogenic bladder
e)outflow obstruction of the bladder

3) 2 month old that smiles spontaneously, vocalizes without crying. Does not laugh or squeal. Doesnt work for toy that is out of reach.
Asses language and psychosocial develoment
I chose both delayed, got it wrong.

4)Program for primary prevention of CAD. How do you monitor the program
a)case faatliy
b)hospitilization
c)incidence
d)mortality
e)prevelence (wrong answer)
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  #73  
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Quote:
Originally Posted by Vaheh View Post
A couple I got wrong if anyone can help
1)Primigravid who gave birth to stillborn at 38 weeks
Most appropriate course of action
a) notify hospital liability dep
b)obtain consent for organ transplant
c)recomend autopsy
d)tell mother not to worry she can get pregnant again (One i chose)
e)tell the parents theres a 1 in 4 chance of it recurring

2) 70 year old man, urinary hesitancy and freq. Temp is 37.5. No urethral discharge. Rubbery,enlarged, non tender prostate. G- rods, no RBCes, many WBCes
a)infection of epididymis
b)infection of the prostate
c)infection of the urethra (one i chose)
d)neurogenic bladder
e)outflow obstruction of the bladder

3) 2 month old that smiles spontaneously, vocalizes without crying. Does not laugh or squeal. Doesnt work for toy that is out of reach.
Asses language and psychosocial develoment
I chose both delayed, got it wrong.

4)Program for primary prevention of CAD. How do you monitor the program
a)case faatliy
b)hospitilization
c)incidence
d)mortality
e)prevelence (wrong answer)
1) recommend autopsy

2)The way posted , its difficult to figure out. But, looks like its bacterial colonization due to outflow obstruction by enlarged prostate

4) primary prevention target on new onset of disesases so , may be incidence is the answer
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  #74  
Old 12-15-2013
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Quote:
Originally Posted by Vaheh View Post
A couple I got wrong if anyone can help
1)Primigravid who gave birth to stillborn at 38 weeks
Most appropriate course of action
a) notify hospital liability dep
b)obtain consent for organ transplant
c)recomend autopsy
d)tell mother not to worry she catn get pregnant again (One i chose)
e)tell the parents theres a 1 in 4 chance of it recurring

2) 70 year old man, urinary hesitancy and freq. Temp is 37.5. No urethral discharge. Rubbery,enlarged, non tender prostate. G- rods, no RBCes, many WBCes
a)infection of epididymis
b)infection of the prostate
c)infection of the urethra (one i chose)
d)neurogenic bladder
e)outflow obstruction of the bladder

3) 2 month old that smiles spontaneously, vocalizes without crying. Does not laugh or squeal. Doesnt work for toy that is out of reach.
Asses language and psychosocial develoment
I chose both delayed, got it wrong.

4)Program for primary prevention of CAD. How do you monitor the program
a)case faatliy
b)hospitilization
c)incidence
d)mortality
e)prevelence (wrong answer)
1c
2e
3 normal
4 c
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  #75  
Old 12-16-2013
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Quote:
Originally Posted by drsrb View Post
yea for that one its reassurance..
with the sore throat one u hv to get throat culture coz rapid strep test is specific but not sensitive and the presentation looks like strep pharyngitis so u hv to do culture to rule out..
and for d pik with rash,,,that was contact dermatitis..so avoidance of d wooded area..
I can verify this guy's all answers are correct.

Anybody remembers incontinence 1 q. It was urge incontinence in multipara gave detrusor instability cause could not make sense with any other choices. My very weak part incontinence will work on it.

And yes i found this nbme 6 very straight forward although didn't end it with great score. I had 15-20 minutes left in each block. Hope my not very good score is not very overestimated by itself.

Last edited by tamta; 12-16-2013 at 08:18 AM.
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  #76  
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Quote:
Originally Posted by tamta View Post
I can verify this guy's all answers are correct.

Anybody remembers incontinence 1 q. It was urge incontinence in multipara gave detrusor instability cause could not make sense with any other choices. My very weak part incontinence will work on it.

And yes i found this nbme 6 very straight forward although didn't end it with great score. I had 15-20 minutes left in each block. Hope my not very good score is not very overestimated by itself.
i dont really remember the incontinence q..but if u want to improve on the topic read it from kaplan gyne n obs its given beautifully there...helped me a lot
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  #77  
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Quote:
Originally Posted by drsrb View Post
i dont really remember the incontinence q..but if u want to improve on the topic read it from kaplan gyne n obs its given beautifully there...helped me a lot

it was very easy simple stress incontinence, i changed the answer stupidly massed up names. dude how i want to be at your place now
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Old 12-17-2013
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Ino... But don't worry just a couple of weeks and u will b done.. So focus on that....
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  #79  
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Originally Posted by drsrb View Post
Ino... But don't worry just a couple of weeks and u will b done.. So focus on that....
yeah.. im focused i will do my best. thanks.
anybody got the question with mechanical ventilation parameters correctly?
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Quote:
Originally Posted by tamta View Post
yeah.. im focused i will do my best. thanks.
anybody got the question with mechanical ventilation parameters correctly?
I did nbme 1 which almost same to nbme 6 . So, the ventilation q I got it wrong. May be withdrawal from MV was the answer.

I couldn't find the explanation any where
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  #81  
Old 12-17-2013
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Quote:
Originally Posted by tamta View Post
yeah.. im focused i will do my best. thanks.
anybody got the question with mechanical ventilation parameters correctly?
even i got that one wrong..i cudnt think of right answer in that and with options till N i didnt read all the options..
what i have gathered from various threads on that qs is as the women is conscious and alert and her abg is normal...the next best step would be to wean her off ventilator..
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  #82  
Old 12-18-2013
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Quote:
Originally Posted by drsrb View Post
even i got that one wrong..i cudnt think of right answer in that and with options till N i didnt read all the options..
what i have gathered from various threads on that qs is as the women is conscious and alert and her abg is normal...the next best step would be to wean her off ventilator..
i had that answer first in my choice.. but don't know why went with dont even remember which answer "increasing resp Rate".
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i had that option hidden in the middle...i dont even remember what i chose on that..but hey i am not complaining..;p
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  #84  
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Quote:
Originally Posted by drsrb View Post
i had that option hidden in the middle...i dont even remember what i chose on that..but hey i am not complaining..;p
lol yeah you better be quiet 265. dude i hope it does not overestimate too much. and i will hopefully at least stick with my 235 and not worsen it in a month. i will write UWSA on jan 7-8 and if i dont get something with 240 in it i will postpone.
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  #85  
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nah it doesn't overestimate much..in my case it did but i was checking the nbme correlation thread and most ppl had within +-5 of nbme 6...maybe i was just lucky that day..some even had had +20 from nbme 6..lol
even with uwsa..most of my seniors at my college had +5 to +10 of their uwsa..no one depreciated..except me..lol
always gonna be some exceptions..
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  #86  
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Quote:
Originally Posted by drsrb View Post
nah it doesn't overestimate much..in my case it did but i was checking the nbme correlation thread and most ppl had within +-5 of nbme 6...maybe i was just lucky that day..some even had had +20 from nbme 6..lol
even with uwsa..most of my seniors at my college had +5 to +10 of their uwsa..no one depreciated..except me..lol
always gonna be some exceptions..
yes, i agree. totally depends on individual performance on exam.
this thread is real helpful, hope to post there soon
NBME, UWSA, Qbanks Averages, Correlation with Real Step 2 CK Exam Score
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  #87  
Old 05-03-2014
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Quote:
Originally Posted by polok15 View Post
I did the question offline and picked malabsorption, I never felt at first it was lactose intolerance, lactose intolerance shouldnot cause abdominal pain
Do u have the link to offline nbme 6? Can't find it anywhere!
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  #88  
Old 05-08-2014
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i was wondering about those qs
1- women with decrease libido after TAH

2-women who has lethargy , and boredom after delivery of her 5 months old son, ?

3-32 women who has cough with white sputum that awakens her at night

4- 47 y .o man with no symptoms , cholesterol 225

5-21 college student , no sexual activity , no s/s , what screening test

6- 67 y.o man with fever and headache and has valve replacement before
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  #89  
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Quote:
Originally Posted by hydrocephalus View Post
i was wondering about those qs
1- women with decrease libido after TAH

2-women who has lethargy , and boredom after delivery of her 5 months old son, ?

3-32 women who has cough with white sputum that awakens her at night

4- 47 y .o man with no symptoms , cholesterol 225

5-21 college student , no sexual activity , no s/s , what screening test

6- 67 y.o man with fever and headache and has valve replacement before

any answer
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  #90  
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Quote:
Originally Posted by made4usmle View Post
Yes CT is next in case of mastoiditis(outward and downward displaced pinna)
If CT shows no destruction of mastoid air cells then do myringotomy + IV antibiotics
If CT shows destruction of mastoid air cells then to Mastoidectomy + IV antibiotics.
Hi, the correct answer is CT , the kid has retroauricular pain...uworl says the u have to rule out mastoiditis specialy when is resistance to antibioterapy. I got tha one right on the test.
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Quote:
Originally Posted by polok15 View Post
it is endometriosis for sure, cause all the choices will be abnormal hormone test
Endometriosis requires dysmenorrhea, dyschezia, and dysperunia to call it that diagnosis. If I can recall, the lady had oligomenorrhea, and according to the Rotterdam criteria for PCOS, you just need 2 of their criteria to be called PCOS.
The question is very ambiguous cause we're trained to select PCOS when we see acne, hirsuitism, elevated androgen, testosterone, DHEAs yet everything on the question steers us away from that except 2 things: acne, oligomenorrhea

To be honest, this question should be removed, its really unfair and it does not gauge a person's ability to know OB/GYN
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Q) Visiting egypt what prophylaxis?

CEftriaxone, Acyclovir, Isoniazid, Albendazole, Mefloquine, Metronidazole, Penicillin

Q) 67 year old person with abd pain, copious vomiting 24 hours. 2 week ago syncronized for afib and started on warfarin. Yesterday stopped warfarin after checking that INR was 6. BP 100/48, 98.6F, 120/min, 20/min. Distended abdomen moderately tender, voluntary gaurding in epigastrium, occult blood in stool negative. HB dropped from 13 to 7.8 since yesterday

Ischemia d.t embolus, hematoma, intussception, malrotation

Q) A 58 year old female with dec libido 8 months ago had TAH, BSO. Is on HRT with estrogen. Moist rugated vagina due to

dec androgen, dec estrogen, dec FSh, dec LH, Dec prog, dec prolactin, inc anfrogen, inc estrogen, Inc LH, inc prolactin, inc progesterone

Q) a man came to ed after his ex wife found him stumbling in the back yard. BP 100/70, pupil are equal and reactive to light sclera is injevted, laughs for no reason. makes religious statement ans ask for food adn water. mild paronia but otherwise normal.
what to do next?
observe, im.naloxone, 5%dextrose, lorazepam, chlorpromazine

Q) 4 hours after undergoing C section the lady complain of dizziness and confusion. Blood loos of 800 reported. B.P falls to 80/40 and was 120/70 intra operatively. pule is 152/min as compared to 96/min. breath sounds dec bilaterally. Abld distended and tender, bowel sounds absent. incison intact with no drainage
HCT 23% as compared to 35% What is all of this due to?
Epidural hypotension
miscalculated intra op fluid loss
underestimated fluid replacement
post op hemolysis
supine hypotension
supine hypotension

Q)A previous healthy 32 y old person with persistant cough. Worse with physical activity, while supine and early morning. Recent URTi. Cigg smoker for 16 years. Rasping cough. Scattered end exp wheeze bilaterally. Peak exp flow rate dec What would you do next?
A) antcholinergic b) antihistaminic c) antibiotic d) b blocker e) mast cell stablizer
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  #93  
Old 08-27-2014
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Default need ur suggestionx guys!

i scored 170 correct out of 184 on NBME6 CK,,, exam in 3 weeks! needs your suggestionx how much predictive this is..... i found it pretty straight forward apart from few wierd questions.
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Default decreased libido

decreased libido is 2/2 low LH.

will update you with other questions too. i am working on it now.
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Quote:
Originally Posted by aliwaqas View Post
i scored 170 correct out of 184 on NBME6 CK,,, exam in 3 weeks! needs your suggestionx how much predictive this is..... i found it pretty straight forward apart from few wierd questions.
hey there i scored 165 out of 184 my 3 digit is 252 was it predictive ?
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  #96  
Old 11-25-2014
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Default please help

hi can someone send me nbme offline forms and answers.. it would be of great help thank u
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Correct Answer

DOC007 QUESTIONS:

Q)Visiting egypt what prophylaxis?

CEftriaxone, Acyclovir, Isoniazid, Albendazole, Mefloquine, Metronidazole, Penicillin

Q) 67 year old person with abd pain, copious vomiting 24 hours. 2 week ago syncronized for afib and started on warfarin. Yesterday stopped warfarin after checking that INR was 6. BP 100/48, 98.6F, 120/min, 20/min. Distended abdomen moderately tender, voluntary gaurding in epigastrium, occult blood in stool negative. HB dropped from 13 to 7.8 since yesterday

Ischemia d.t embolus, small bowel hematoma, intussception, malrotation

Q) a man came to ed after his ex wife found him stumbling in the back yard. BP 100/70, pupil are equal and reactive to light sclera is injevted, laughs for no reason. makes religious statement ans ask for food adn water. mild paronia but otherwise normal.
what to do next?
observe, im.naloxone, 5%dextrose, lorazepam, chlorpromazine
THC intoxication = injected sclera plus he is asking about food

Q) 4 hours after undergoing C section the lady complain of dizziness and confusion. Blood loos of 800 reported. B.P falls to 80/40 and was 120/70 intra operatively. pule is 152/min as compared to 96/min. breath sounds dec bilaterally. Abld distended and tender, bowel sounds absent. incison intact with no drainage
HCT 23% as compared to 35% What is all of this due to?
Epidural hypotension
miscalculated intra op fluid loss
underestimated fluid replacement
post op hemolysis
supine hypotension
supine hypotension

ANSWERS IN BOLD
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  #98  
Old 02-03-2015
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Quote:
Originally Posted by Ergo Proxy View Post
Endometriosis requires dysmenorrhea, dyschezia, and dysperunia to call it that diagnosis. If I can recall, the lady had oligomenorrhea, and according to the Rotterdam criteria for PCOS, you just need 2 of their criteria to be called PCOS.
The question is very ambiguous cause we're trained to select PCOS when we see acne, hirsuitism, elevated androgen, testosterone, DHEAs yet everything on the question steers us away from that except 2 things: acne, oligomenorrhea

To be honest, this question should be removed, its really unfair and it does not gauge a person's ability to know OB/GYN
YES the answer is PCOS, I answered that just by ruling out the others even though I wasnt as convinced cause I too agree its unfair since testosterone is very increased in these patients.
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  #99  
Old 02-04-2015
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PLEASE I NEED HELP WITH THIS QUESTIONS

A 7-year-old girl is brought to the physician in September because of fever and sore throat for 1 day. She is in the third week of second grade. Her temperature is 38.6 C (101.5 F). Examination shows an erythematous pharynx and slightly enlarged tonsils without exudate. There is no significant cervical lymphadenopathy. A rapid test for group A streptococcus is negative. Which of the following is the most appropriate next step in management?

A) Throat culture
B) Monospot test
C) Intramuscular penicillin therapy
D) Oral erythromycin therapy
E) Oral penicillin therapy

I believe the answer is A. but could someone please explain WHY?

1. a 67-year old man is examined 3 days after undergoing uncomplicated coronary artery bypass grafting. He has HTN, CHF,and hypercholesterolemia. his medications are patient controlled morphine, a laxative, lisinopril, metoprolol, furosemide, and lovastatin. he is alert and fully oriented. his temperature is 37.8, pulse is 67/min, RR are 18/min, and bp is 128/72mmHg. examinations show claen, dry, well-healing surgical incisions over the sternum and right lower extremity. mental status exam shows a bright affect. a urinary catheter is in place. the patient is able to move from the bed to a chair with the help of physical therapy. he will soon be transferred from ICU. Which of the followings is the most appropriate next step to prevent iatrogenic complications in this patient?

a. remove the urinary catheter
b. begin famotidine tx
c. begin subQ heparin tx
d. discontinue furosemide
e. switch from morphine to aap-hydrocodone

ANSWER Is A according to other websites and I just read CDC guidelines concerning indwelling urinary catheters and they have this: Leave catheters in place only as long as needed
– Remove catheters ASAP postoperatively, preferably
within 24 hours,

but why not C?? since its a major heart surgery that can involve thromboembolic complications??
thanks!


An asymptomatic 57-year-old man comes to the physician for a routine health maintenance examination. He has smoked one pack of cigarettes daily for 37 years. His blood pressure is 180/112 mm Hg, and pulse is 82/min. Abdominal examination shows a bruit in the right upper quadrant and no masses. His hematocrit is 42%, serum urea nitrogen (BUN) level is 23 mg/dL, and serum creatinine level is 1.4 mg/dL. Which of the following is the most likely cause of this patient's bruit?

A) Accumulation of lipids in the arterial wall
B) Hypertrophy of the arterial wall media
C) Infiltration of arterial wall by giant cells
D) Infiltration of round cells in the arterial wall
E) Reflex vasodilation

I answered C which is INCORRECT, why not aortic disease due to hypercholesterolemia that weakened the vessel wall and lead to aneurysm??

Q. A previously healthy 16-year-old boy is brought to the physician because of fever and cough with right-sided chest pain for 2 weeks. Six months ago, he visited his grandparents in Albania for 2 weeks. He weighs 54 kg (120 lb) and is 173 cm (68 in) tall. He appears thin and pale. His temperature is 38.2 C (100.8 F), pulse is 76/min, and respirations are 36/min. Examination shows shallow respirations with decreased breath sounds at the right lung base. An x-ray film of the chest shows a right pleural effusion and hilar adenopathy.

A )alphaAntitrypsin deficiency
B ) Cystic fibrosis
C ) Pneumothorax
D ) Pulmonary alveolar proteinosis
E ) Pulmonary aspergillosis
F ) Pulmonary hemorrhage
G ) Pulmonary tuberculosis

incorrect is D

Last edited by drpisho; 02-04-2015 at 02:16 PM.
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  #100  
Old 02-04-2015
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got all answers. nevermind!
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