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NBME 15 Answers

Block 1/Question#6
A 7-year-old boy is brought to the physician because of a ...
Virion release

Block 1/Question#9
A healthy 3-year-old boy has a cleft lip and palate. He has ...
Multifactorial

Block 1/Question#10
Which of the following best explains why deoxygenated blood ...
Deoxyhemoglobin is a better buffer of hydrogen ions than oxyhemoglobin

Block 1/Question#11
A 9-year-old boy has mild mental retardation and a 4-year ...
Tuberous sclerosis

Block 1/Question#15
A 48-year-old woman comes to the emergency department because ...
Increased cardiac parasympathetic activity

Block 1/Question#19
A 65-year-old man with a history of ischemic heart disease ...
33%

Block 1/Question#24
A 3-year-old girl is brought to the physician because of a ...
Interferon-gamma receptor

Block 1/Question#32
A 4-day-old male newborn who was born at home is brought to ...
First

Block 1/Question#33
A 75-year-old woman is brought to the physician because of a ...
Releases NF-κB after undergoing phosphorylation

Block 1/Question#35
One-half hour after an uncomplicated vaginal delivery, a ...
Oxytocin

Block 1/Question#37
A 36-year-old man who is heterozygous for an LDL-receptor ...
LDL receptor

Block 1/Question#38
A 23-year-old woman comes to the physician because of a 3-day ...
Oculomotor nerve

Block 1/Question#39
An investigator is designing a study to compare a new ...
Stratification

Block 1/Question#44
A 59-year-old man comes to the physician because of a 10-day ...
Imatinib

Block 1/Question#46
A 6-year-old boy with severe mental retardation and ...
0.2 to 0.5

Block 1/Question#48
A 22-year-old man is brought to the emergency department 30 ...
Deep fibular (peroneal)

Block 1/Question#49
A 23-year-old woman comes to the physician because of a ...
Glucokinase

Block 1/Question#50
A healthy 25-year-old man participates in a study of muscle ...
epp Amplitude: 1; mepp Amplitude: 1; Response to Ach: 1

Block 2/Question#3
A 2-year-old girl is brought to the emergency department 20 ...
Atropine

Block 2/Question#4
A 32-year-old man comes to the physician for his annual ...
Schizoid personality disorder

Block 2/Question#6
A 56-year-old woman comes to the physician because of a ...
Helicobacter pylori

Block 2/Question#9
A 67-year-old man is brought to the physician because of a ...
Aneurysm of the posterior communicating artery

Block 2/Question#11
A previously healthy 48-year-old man is brought to the ...
Degenerating epithelial cells and dirty brown granular casts

Block 2/Question#14
A 25-year-old woman with a history of rheumatic fever and ...
Streptococcus mitis

Block 2/Question#15
A 64-year-old man comes to the physician because of a 2-month ...
Increased fibrosis in the interstitium

Block 2/Question#20
A 30-year-old man is brought to the physician by his wife ...
Porphobilinogen deaminase

Block 2/Question#21
A 43-year-old woman comes to the physician because of a ...
Complex partial

Block 2/Question#22
A 22-year-old woman is found to be HIV positive after sexual ...
Protein processing

Block 2/Question#23
A previous healthy 26-year-old woman comes to the physician ...
Area labeled by letter 'E'

Block 2/Question#26
A 47-year-old man is admitted to the hospital for treatment ...
Increased pulmonary capillary pressure

Block 2/Question#28
A 35-year-old woman, gravida 1, para 1, comes to the ...
Nicotinic acetylcholine receptor

Block 2/Question#29
A 2-month-old male infant is brought to the emergency ...
Glycine receptor

Block 2/Question#31
A 24-year-old woman with Marfan syndrome comes to the ...
Hypervolemia

Block 2/Question#32
A 25-year-old primigravid woman at 25 weeks' gestation comes ...
Prematurity

Block 2/Question#36
A 72-year-old woman is admitted to the hospital because of an ...
Left coronary, circumflex, posterior interventricular (posterior descending)

Block 2/Question#39
A 43-year-old man with a 10-year history of alcoholism comes ...
Decreased glutathione

Block 2/Question#40
A 4-year-old boy is brought to the physician by his father ...
Cytoskeleton

Block 2/Question#41
A 45-year-old man comes to the physician for an initial ...
Mitral regurgitation

Block 2/Question#43
A 37-year-old woman is brought to the emergency department ...
Cardiogenic

Block 2/Question#45
A 3-year-old girl is brought to the physician because of a ...
Abnormal targeting of these enzymes to lysosomes

Block 2/Question#47
A 75-year-old man with chronic obstructive pulmonary disease ...
C5a

Block 2/Question#49
A study was begun in the 1950s to determine the causes of ...
Cohort study

Block 3/Question#3
A 56-year-old woman is brought to the emergency department by ...
Lipopolysaccharide

Block 3/Question#6
A 50-year-old man comes to the physician for a routine health ...
Medullary

Block 3/Question#7
A 1-year-old boy is brought to the physician by his parents ...
RNA splice error

Block 3/Question#9
A newborn undergoes surgical repair of esophageal atresia. ...
Endoderm

Block 3/Question#10
A 5-year-old boy is stung on his foot by a bee. Within 30 ...
Gap formation between endothelial cells

Block 3/Question#15
A 65-year-old man with hypertension volunteers to participate ...
Acid-base: Metabolic alkalosis; Volume contraction: yes

Block 3/Question#18
A 27-year-old man comes to the physician because of a 3-hour ...
Prolonged fecal excretion of the organism

Block 3/Question#24
A 28-year-old African American man comes to the physician ...
Ethnicity

Block 3/Question#30
A 13-year-old boy is scheduled to receive chemotherapy for a ...
T-lymphocyte thymocytes localized to the thymic cortex

Block 3/Question#32
A 2-month-old girl is brought to the physician for a ...
Congenital neutropenia

Block 3/Question#39
A 42-year-old woman with multiple sclerosis is brought to the ...
Medial longitudinal fasciculus

Block 3/Question#43
An 18-year-old man is brought to the physician by his father ...
Inquiry about a history of anabolic steroid use

Block 3/Question#45
A 30-year-old woman has had Hodgkin disease that was ...
Therapy for Hodgkin disease causes mutations in hematopoietic stem cells, and one mutant cell progresses to leukemia

Block 3/Question#47
A 2-month-old boy is brought to the physician because of ...
Peroxisomes

Block 3/Question#48
A paper says, "We chose the sample size to have an 80% power ...
5%, Type I error

Block 4/Question#3
A 51-year-old man with a 5-year history of Wegener ...
Hematuria

Block 4/Question#5
A male newborn is delivered at term with a right-sided aortic ...
Third and fourth branchial pouches

Block 4/Question#7
A 17-year-old boy with chronic renal insufficiency undergoes ...
Hydronephrosis

Block 4/Question#8
A newborn delivered at 28 weeks' gestation is in severe ...
Lung elastic recoil

Block 4/Question#9
A 40-year-old woman with breast cancer is brought to the ...
Occipital lobe

Block 4/Question#11
A 45-year-old man comes to the physician for a follow-up ...
Venous return: decreased; Carotid sinus baroreceptor activity: decreased; Cerebral blood flow: decreased

Block 4/Question#17
A previously healthy 18-year-old woman comes to the physician ...
β-Lactamase production

Block 4/Question#20
A 52-year-old man is brought to the physician 3 days after ...
No constriction because the retinal ganglion cells in the left eye have been destroyed

Block 4/Question#25
A couple has two children with osteogenesis imperfecta type ...
Germline mosaicism

Block 4/Question#26
A 65-year-old woman comes to the physician for a follow-up ...
Osteoblast activity: decreased; Osteoclast activity: increased; RANKL: increased

Block 4/Question#29
A 45-year-old woman (III,7) comes to the physician for a ...
Incomplete penetrance

Block 4/Question#30
A 25-year-old woman comes to the physician because of ...
Nuclear/retinoid X binding to DNA

Block 4/Question#32
A 70-year-old woman is found dead in her bed in a skilled ...
Hypertrophy

Block 4/Question#33
During a series of normal skeletal muscle twitches, the ATP ...
ATP is quickly regenerated from creatine phosphate

Block 4/Question#38
A 25-year-old woman comes to the physician because of general ...
Thrombocytopenia

Block 4/Question#40
An 18-month-old boy with severe combined immunodeficiency ...
Irradiated packed red blood cells

Block 4/Question#42
A 4-year-old boy with a karyotype of 47,XY+21 develops ...
Excess lymphoblasts

Block 4/Question#44
A 72-year-old woman comes to the physician because of diffuse ...
Osteomalacia

Block 4/Question#47
A 31-year-old woman is treated for Plasmodium vivax malaria ...
Primaquine kills hypnozoites

Block 4/Question#48
A study is conducted to evaluate the effectiveness of cough ...
Lack of blinding between groups

Recent comments ...

... fuckster made a comment on nbme15/block1/q#9 (3 yo boy, cleft lip and palate, no other birth defects)
 +0  upvote downvote
submitted by fuckster(-44)

[special]

... ergogenic22 made a comment on nbme15/block2/q#3 (2 yo girl, brought to ER, 20 minutes after ingesting insecticide)
 +0  upvote downvote
submitted by ergogenic22(28)

vitals and need to be treated first, so atropine and then pralidoxime.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2493390/

important to note that organophosphates become irreversible at a certain point so pralidoxime does still need to be given early

... ergogenic22 made a comment on nbme15/block2/q#6 (56 yo woman, 3 weeks progressive difficulty swallowing)
 +0  upvote downvote
submitted by ergogenic22(28)

mass in the esophagus with solid/liquid dysphagia. I'm not sure what the histo shows but on the bottom there are more flat cells and the top there are wider spaces within the cells with some fat, so I think it maybe a healing ulcer leading to a stricture.

anways other pathogens are more associated with other infections

A) gallstones and cholangiocarcinoma B) esophagitis c) liver abscess E) i think miliary TB can present in the liver

... ergogenic22 made a comment on nbme15/block2/q#6 (56 yo woman, 3 weeks progressive difficulty swallowing)
 +0  upvote downvote
submitted by ergogenic22(28)

mass in the esophagus with solid/liquid dysphagia. I'm not sure what the histo shows but on the bottom there are more flat cells and the top there are wider spaces within the cells with some fat, so I think it maybe a healing ulcer leading to a stricture.

anways other pathogens are more associated with other infections

A) gallstones and cholangiocarcinoma B) esophagitis c) liver abscess E) i think miliary TB can present in the liver

... ergogenic22 made a comment on nbme15/block2/q#9 (67 yo man, 2 days double vision and drooping left eyelid)
 +0  upvote downvote
submitted by ergogenic22(28)

He has a down and out pupil, caused by CN III palsy. His gaze is due to unopposed action of the lateral rectus and superior oblique; ptosis due to denervation of levator palpebrae superiosis.

The only injury listed that could cause a CN III palsy is aneurysm of the PCA compressing the ocularmotor nucleus.

... ergogenic22 made a comment on nbme15/block2/q#14 (25 yo woman, rheumatic fever and mitral valve prolapse, 2 weeks of fever, fatigue)
 +0  upvote downvote
submitted by ergogenic22(28)

Strep Viridans is oral flora, causes subacute endocarditis affecting previously damaged valves, and is often associated with sequelae of dental procedure.

A) enterococci can also cause subacute endocarditis but they are gamma hemolysis and follow GI/GU procedure B) beta hemolysis and causes acute c) beta hemolysis and causes acute e) alpha hemolysis but unlikely to cause endocarditis, causes meningitis, otitis, pneumonia, sinusitis - (MOPS)

... ergogenic22 made a comment on nbme15/block2/q#15 (64 yo man, 2 months progressive shortness of breath)
 +0  upvote downvote
submitted by ergogenic22(28)

TLC decreased suggests restrictive disease. Reticular pattern suggests pulmonary fibrosis

... ergogenic22 made a comment on nbme15/block2/q#21 (43 yo woman, 6 months altered consciousness)
 +0  upvote downvote
submitted by ergogenic22(28)

She has motor and sensory symptoms. This r/o both kinds of simple. Her seizures are not described as tonic/clonic movements, and include periods of impaired consciousness. This rules out generalized tonic/clonic. There is a post-ictal state, that rules out absence.

Also the lip smacking is characteristic of automatism, which is found in complex partial seiuzres

... ergogenic22 made a comment on nbme15/block2/q#26 (47 yo man, admitted to hospital for myocardial infarction)
 +0  upvote downvote
submitted by ergogenic22(28)

Acute MI and mitral regurg (from the murmur) leads to LV failure and backflow of blood into the lungs.

This leads to increased pulmonary hydrostatic capillary pressure. This will lead to excess volume leaking from the pulmonary capillaries into the interstitial and this will manifest as pulmonary edema (crackles).

Pulmonary edema will interfere with gas exchange leading to hypoxemia.

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