NBME Answers : medskool123's page

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+1 visit this page (nbme24#7)

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how did you know it was a strawberry hemangioma and not a port wine stain?I thought I had this one in the bank

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kateinwonderland Me too! TABLE 1 Classification of Vascular Lesions Vascular malformations (flat lesions) -Salmon patch (also known as nevus simplex or nevus telangiectaticus) -Port-wine stain (also known as nevus flammeus) Hemangiomas (raised lesions) -Superficial hemangioma (also known as capillary nevus hemangioma) -Deep hemangioma (also known as cavernous hemangioma) https://www.aafp.org/afp/1998/0215/p765.html +

krewfoo99 Because they describe the lesion as cavernous vascular channels +2

covid2019 After looking into it, port wine stain comes as part of Sturge Weber SYNDROME. Given that this child was coming in for a well-child examination, they're implying there's no other symptoms (SWS would have signs of other vascular malformations like in the CNS--> epilepsy). +

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can someone explain why this is not transduction? Last nbme I said conjugation and got it wrong for transduction.. this one I say transduction and its conjugation.

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pseudorosette I would say because this happened between two bacteria, but in transduction what causes the acquisition of bacterial resistance is coming from a bacteriophage, which is a virus that infects bacteria, but that is never hinted at the question! +5

medpsychosis Quick Overview of the involved topics and answer choices that are relevant in this question: Transduction: Involves phage, cleaves DNA and takes a part with it as it is packaged. Generalized is when is happens by accident. Specialized is an excision event. Transformation: bacteria takes up naked DNA around it and incorporates it therefore becoming "transformed" e.g. (SHiN) S. Pneuma, H. Influenza type B, and Neisseria. Transposition: Jumping from one location to another within same bacterial organism (e.g. from chromosome to plasmid) Conjugation: Above mentioned plasmid gets transferred from conjugal bridge from one bacteria to another. +21

wowo FA2019 p130 +1

zbird Easy here...first both are G-ves which likely have a sex pilus and if cultured together as in this case transfer their plasmid. Transduction need phage. Transposition is exchange of genetic material inside the bacteria b/n the dna and the plasmid or vv (FA2019) +

impostersyndromel1000 how much time do you really save by saying G-ves instead of gram negs or negatives +

unknown001 can someone explain why it isnt transposition. reason why it isnt transformation is there is nothing in the broth that will cleave the bacteria, to have naked dna that can be picked up +

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submitted by m-ice(370), visit this page

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This girl has Mono caused by Epstein-Barr Virus. The symptoms are relatively vague, but lymphadenopathy like this would be common for Mono. The CBC shows elevated lymphocytes, implying this is not a bacterial illness, so viral is likely. Combined with the lymphadenopathy, this makes us worry about Mono. The Mono-Spot test for EBV is what the question is referring to when describing the sheep erythrocytes agglutinating. From there, this question requires that you know that in EBV infection, EBV infects B cells, but does not cause them to become abnormal. Instead, CD8 cells, which are actively trying to kill the B cells, become abnormal.

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medskool123 NBME does trick now and then.. when they zig you zag. then when you think they are going to zag, they zig just to destroy yourself confidence. +18

kylemax The abnormal T-cells are known as Downey type II cells (Sketchy) +4

haliburton I was recognized EBV, then knew EBV infects Bc, and the atypical lymphocytes are Tc. Then I said CD8 are MHC1 for virii, and bingo bango, boom. +6

trichotillomaniac congrats you played yourself +3

lilyo Soooooooo EBV infested B- cells is not considered atypical WTFF?? +

med4fun They are atypical b/c usually you do not see a super high amount of CD8+ in peripheral blood. Now there are a ton to try to stop the infected cells. +1

aneurysmclip oh and primary CNS lymphoma caused by EBV has T cells NOT B cells. I just try to remember the peripheral blood has atypical lymphocytes which are CD8+ T cells, and the CNS lymphoma is the opposite, ie; B cells +

submitted by lsmarshall(465), visit this page

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I thought this was a trick question since skin cancers are the most common type of cancers overall. But actually among HIV patients, HIV-related cancers are much more common than non-HIV-related cancers (even skin cancers). EBV-induced primary CNS lymphoma is the only option that is AIDs-defining illness/cancer.

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medskool123 why not hep B? i guess another whats the better answer ones... Just rem reading that it was more common with aids pts.. anyone have an idea about this? +1

haliburton Yes, I think CNS lymphoma as an AIDS defining illness wins the day. My thought was since SHE has AIDS it is most likely from IVDA, which has a high risk of HBV that could go undiagnosed for a long time. at 32, that might not be long enough to have HBV and get HCC (but with no immune system...?) +3

yotsubato God damn this is such BULLSHIT... +15

trichotillomaniac Why you gotta do me dirty like this NBME +2

sars My thought process, usually wrong all the time, was that HBV (IVDU) can occur to anyone. Acute hepatitis to Chronic occurs when HBV incorporates its DNA into host and releases mutagenic proteins. This is regardless of immunosuppresion. Primary CNS Lymphoma reappears primarily when you are immunosuppressed (organ transplant, immunodeficiency, HIV/AIDS). +2

syoung07 Hep C is far more likely to become HCC than hep B +2

jurrutia Even if you were thinking skin cancer is more common, that's only true for basal cell and squamous. Melanoma is rare. EBV much more likely in aids patient. Even H pylori was a better answer. +

submitted by neonem(630), visit this page

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This patient has an unstable mood and a crazy relationship. She's also splitting (a defense mechanism wherein one acts like people are all-good or all-bad) as she talks about the physician and her coworkers. This characteristic is most commonly associated with borderline personality disorder. This one is in Group B ("Wild"), along with antisocial, histrionic, and narcissistic.

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medskool123 i get why its borderline now (I guess I kind of always thought suicide was the biggest part of that) but can someone tell me why its not paranoid? Is it just a matter of the "better" choice? The "youre the only one i can trust" thing lead me to that. +2

drmomo same here +

aneurysmclip Paranoid is where they don't trust anyone or are weary of people. because she said she trusts only the physician can be a bit confusing, but she describes her coworkers as jerks, not that "oh they're out to kill me, they're government agents watching me" +1

boostcap23 Splitting association with borderline in FA 2020 pg 555 and 565 +1

failingnbme got this wrong too but yes I guess paranoid will be suspicious with everyone +

fatboyslim Paranoid is suspicious of everyone. Like that one question in UWorld where a patient is evaluated in the ER and found to have appendicitis and recommended to have surgery. Patient then tells the doc "you're just trying to make use of my amazing insurance" + when asked about if he has any relatives or people that help care for him he says "I haven't talked to my family in 10 years, they all want something from me" or something along those lines. Borderline usually stands out when you see a malfunctioned relationship +/- post-breakup and the patient does something like try to commit suicide etc. plus having that splitting mentality "you're the only one I can trust, everyone else is a jerk". +

submitted by mousie(272), visit this page

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A Teen with injection of both conjunctiva = weed could also be abusing other drugs Is 12 years old and four months just too old and too long of a time for it to be impetigo? I narrowed it down to these two and guessed but... I wasn't sure I could eliminate it.

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medskool123 I picked impetigo because of the gold stippling... I guess I took that as honey crusted lesions. F*ck NBME. +8

yotsubato Huffing gold spray paint. A la the chrome huffers in Mad Max +7

subclaviansteele LOL I think that might be what they were going for here. Gold spray paint. +3

et-tu-bromocriptine Anyone know what may be causing his weight loss and unwillingness to eat? I thought too much into it and put "mercury poisoning", since I thought the heavy metal's abdominal symptoms may have caused him to not want to eat. ¯_(ツ)_/¯ +3

covid2019 I'm not sure about the pathophysiology there... But I do know that inhalants are popular in places where there's extreme poverty. I spent some time abroad, and one of the patients was using inhalants to take the edge off the hunger, so that she could spend her money on food for her kids instead. She also worked on the streets so I guess it also made it easier to, you know... +2