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Old 08-11-2015
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Default NBME 17 question

Hey I need help finding out the answer to this question
A 60 year old man emigrated from china to usa is brought to the physician because of a 1 month history of progressive confusion and swelling of the abdomen and legs. he has no history of major medical illness. he was a peanut framer in china and has smoked 1 pack /day for 40 years. no alcohol. physical examination shows ascites and ankle edema. the liver is palpable and firm at the right costal margin, the spleen is not palpable. serum studies show"
albumin 4 g/dL
total bilirubin 2.5 mg/dL
alk phos 200 U/L
ast 45 U/L
alt 60 U/L
IgG anti hep A virus - positive
anti-hep B - negative
anti-hep C - negative
ultrasonography shows 10- com hypodense lesion in the right lobe of the liver. biopsy shows dysplastic hepatocytes in small clusters and rows of 3-4 cells in thickness. no normal architecture. exposure to which explains the biopsy findings

a) aflatoxins
b) hep A virus
c) mercury
d) nicotine
e) nitrosamines
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Old 08-11-2015
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I think the answer is aflatoxin

"Aflatoxins have been isolated from all major cereal crops, and from sources as diverse as peanut butter and cannabis. The staple commodities regularly contaminated with aflatoxins include cassava, chillies, corn, cotton seed, millet, peanuts, rice, sorghum, sunflower seeds, tree nuts, wheat, and a variety of spices intended for human or animal consumption. When processed, aflatoxins get into the general food supply where they have been found in both pet and human foods, as well as in feedstocks for agricultural animals. Aflatoxin transformation products are sometimes found in eggs, milk products, and meat when animals are fed contaminated grains"

Last edited by Motivated03; 08-11-2015 at 01:14 PM.
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Old 08-12-2015
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There is another question

A 28 year old woman at 18 weeks gestation has palpitations. Laboratory studies show an increased serum total thyroxine (T4) concentration. Which of the following is the best test to confirm a diagnosis of hyperthyroidism in this patient?

a) Fine needle aspiration biopsy of the thyroid gland
b) free T4
c) radioactive iodine uptake
d) serum T3
e) thyroid antibodies

I realized that since she is pregnant her total T4 is elevated due to the liver producing increased thyroid binding globulin. So I am guessing it should be free T4. But I am not sure so could anyone please confirm it for me.

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Old 08-13-2015
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Default Bello

first of all radioactive Iodine uptake test CANNoT be perform due to pregnancy, even though the amount of radiation used is very small, women who are pregnant or breastfeeding should not take the test to avoid risk of exposure to fetus or infant.
Hyperthyroidism during pregnancy makes an antibody with immune system known as thyroid stimulating immunoglobulin. This acts by releasing T3 and T4 more than the normal amount of thyroid hormones. The best way to diagnose hyperthyroidism during pregnancy is by blood test T3 and T4 levels usually the result is high.. TSI test Is your answer E which to me is the BEST answer...
Extremely high levels of thyroid stimulating immunoglobulin lead to GRAVES disease which is caused by the production of antibodies that stimulate thyroid gland .. Measuring is during the third trimester...
Remember that hyperthyroidism during pregnancy leads to Graves' disease is about 80%. There's only two choices lab exams and physical exam to diagnosed....

I hope it helps....

I haven't take NBME 17 yet... I took NBME 13 As my first exam to begin my preparation for the exam... My score 700 or 271... My school required more than 500 to release my documents to ecfmg...

Let's hope someone with more experience and knowledge can help....
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Old 08-14-2015
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The answer to your second question is Free T4 levels. i picked that on my exam and it wasn't in my wrong questions list.
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Old 08-19-2015
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Correct Answer

For the first question

Aflatoxin (hint: peanut, liver symptoms, histo suggestive of liver tumor)

Second question

free T4.
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