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NBME 23 Answers

Block 1/Question#1
An asymptomatic 30-year-old woman comes to the physician for ...

Block 1/Question#2
A 56-year-old woman comes to the physician for a health ...
Microbial oncoprotein that interferes with tumor suppressor proteins

Block 1/Question#3
A 52-year-old man comes to the physician because of severe ...

Block 1/Question#4
A male newborn has a myelomeningocele that involves the ...
Closure of the caudal neuropore

Block 1/Question#5
A study is conducted to examine the effectiveness of a newly ...
Phase 2

Block 1/Question#6
A 32-year-old woman comes to the emergency department after ...

Block 1/Question#7
Which of the following is present in integral plasma ...
Transmembrane region

Block 1/Question#8
A 30-year-old man with HIV infection comes to the office for ...
It increases plasma concentrations of other PIs also metabolized by cytochrome P450

Block 1/Question#9
A 45-year-old man is brought to the physician by his parents ...

Block 1/Question#10
A 13-year-old girl is brought to the office because of a ...
Staphylococcus aureus

Block 1/Question#11
A 55-year-old man who has a 10-year history of type 2 ...

Block 1/Question#12
A 48-year-old man who is a farmer in a remote area of India ...
Blockade of postsynaptic inhibition of spinal motor reflexes

Block 1/Question#13
A researcher is asked to prospectively investigate the ...
Prevalence: above the standard; Incidence: above the standard

Block 1/Question#14
A 65-year-old woman develops deep venous thrombosis of the ...
Heparin-induced thrombocytopenia

Block 1/Question#15
A 26-year-old man who is a Peace Corps volunteer comes to the ...
0.9% Saline

Block 1/Question#16
Physical analysis of the isolated genomic DNA from a mutant ...

Block 1/Question#17
A 54-year-old woman comes to the physician because of a ...

Block 1/Question#18
A 15-year-old boy has nasal polyps and develops bronchospasms ...
Enzyme B

Block 1/Question#19
Unlike the DNA polymerases found in Escherichia coli, RNA ...
Mistakes in transcription are not transmitted to progeny

Block 1/Question#20
A 22-year-old woman at 12 weeks' gestation comes to the ...
Hydropic villi with central cisterns

Block 1/Question#21
A 40-year-old woman with a history of low-grade follicular ...
Bacterial pneumonia

Block 1/Question#22
An investigator is studying the adverse effects of a ...
Presentation of antigens to CD8+ T lymphocytes

Block 1/Question#23
A 35-year-old man comes to the physician because of a tremor ...
Anticholinergic agent

Block 1/Question#24
A 39-year-old man comes to the physician because of darkening ...

Block 1/Question#25
A 5-year-old boy who is undergoing induction chemotherapy for ...
Varicella-zoster virus

Block 1/Question#26
A couple comes to the physician for counseling prior to ...

Block 1/Question#27
An 11-year-old boy is brought to the physician by his mother ...
Sexual abuse

Block 1/Question#28
An otherwise healthy 82-year-old man is brought to the ...
Posterior cord syndrome

Block 1/Question#29
A 34-year-old woman with a 5-year history of hepatitis C ...
Infiltration of lymphocytes, plasma cells, and macrophages

Block 1/Question#30
A 52-year-old man comes to the physician because of inability ...
Pelvic splanchnics

Block 1/Question#31
A 16-month-old boy is brought to the physician for a ...
Absence of germinal centers in lymph nodes

Block 1/Question#32
Which of the following sets of serum findings is most likely ...
Phosphate: increased;
Ca2+: decreased;
Parathyroid hormone: increased

Block 1/Question#33
A 25-year-old woman and her 25-year-old husband come to the ...
α-Thalassemia trait

Block 1/Question#34
A 64-year-old woman is found dead at the foot of her basement ...
Metastatic breast cancer

Block 1/Question#35
A 42-year-old woman comes to the physician because of a ...
Binding of permeable ligand to nuclear transcription factor

Block 1/Question#36
A medical student is caring for a 72-year-old man who has ...
Let me get the resident physician so we can go over the results.

Block 1/Question#37
A 47-year-old woman with multiple sclerosis is brought to the ...
Fasciculus gracilis

Block 1/Question#38
A 43-year-old woman sustains multiple fractures and ...
Hyaline membranes

Block 1/Question#39
A 65-year-old man who is a farmer comes to the physician ...
Disruption of DNA strands secondary to ionization effect

Block 1/Question#40
Which of the following properties of integral membrane ...
Extensive hydrophobic interactions between the amino acid side chains of the protein and the membrane phospholipid tails

Block 1/Question#41
A 62-year-old woman is brought to the emergency department 30 ...

Block 1/Question#42
A 68-year-old woman comes to the office because of a 3-month ...
Retroperitoneal fibrosis

Block 1/Question#43
A 65-year-old woman has the recent appearance of a lesion at ...

Block 1/Question#44
A 34-year-old woman is brought to the emergency department 30 ...
Area labeled ‘D’ (Spinothalamic tract, right)

Block 1/Question#45
A 56-year-old woman comes to the physician because of a ...
Presynaptic release of acetylcholine

Block 1/Question#46
A 31-year-old primigravid woman at 28 weeks' gestation comes ...

Block 1/Question#47
A 61-year-old man comes to the emergency department because ...
Budd-Chiari syndrome

Block 1/Question#48
A 20-year-old man is brought to the emergency department by ...
3,4-Methylenedioxymethamphetamine (MDMA)

Block 1/Question#49
Electrical stimulation of the stellate ganglion is most ...
Heart rate

Block 1/Question#50
A 45-year-old woman with coronary artery disease and anemia ...

Block 2/Question#1
A 26-year-old woman comes to the physician because of a ...
Tinea corporis

Block 2/Question#2
Cyclophosphamide and some other chemotherapeutic agents kill ...

Block 2/Question#3
A prospective study is done to assess the relative efficacy ...
Include the outcome for each participant in the group to which he or she was randomized

Block 2/Question#4
An 18-year-old woman comes to the physician because of a ...
Maximum oxygen consumption (VO2max): decreased;
Venous blood lactate: increased;
Energy production by glycolysis: increased

Block 2/Question#5
A female newborn develops respiratory distress. Her ...
Osteogenesis imperfecta, type I

Block 2/Question#6
A 6-month-old girl is brought to the office for a well-child ...
Hepatitis B

Block 2/Question#7
A 45-year-old man is brought to the emergency department ...
Hypovolemic shock

Block 2/Question#8
An 8-year-old boy is brought to the physician by his mother 6 ...
Serum calcitonin concentration

Block 2/Question#9
A 60-year-old man has had easy fatigability, loss of ...

Block 2/Question#10
A 50-year-old man who lives in eastern Minnesota comes to the ...
Babesia microti and Borrelia burgdorferi

Block 2/Question#11
An antiserum is elicited by immunization with protein X, and ...
Proteins X and Y have no epitopes in common

Block 2/Question#12
A 75-year-old woman has stress urinary incontinence with ...
Stimulation of α-adrenoreceptors

Block 2/Question#13
A 45-year-old man comes to the office for a health ...
Invasion of the submucosa

Block 2/Question#14
A 65-year-old woman with diabetic ketoacidosis has had a ...

Block 2/Question#15
A child with septicemia has an antibiotic clearance (Cl) of ...

Block 2/Question#16
Which of the following best explains impaired action ...
Increase in axonal capacitance

Block 2/Question#17
A 21-year-old man comes to the physician because of a 1-month ...

Block 2/Question#18
A 48-year-old man comes to the physician because of a 24-hour ...
Perforated peptic ulcer

Block 2/Question#19
A 70-year-old man with severe congestive heart failure has ...
Serum BUN: 40;
Serum creatinine: 2;
Urine Na+: 5;
Urine specific gravity: 1.025

Block 2/Question#20
A 47-year-old woman has had a goiter for 10 months. She has ...
Replacement of thyroid parenchyma by lymphoid cells

Block 2/Question#21
A 55-year-old man comes to the physician because of a 1-year ...
FEV1/FVC: normal;
FVC: decreased;
Diffusing capacity of the lung for carbon monoxide: decreased

Block 2/Question#22
A 42-year-old man comes to the physician because of a 1-month ...
Sand fly

Block 2/Question#23
A 75-year-old man with prostate cancer has metastases to the ...
Prostatic venous plexus to the vertebral venous plexus

Block 2/Question#24
A 46-year-old woman has a 1-day history of high-grade fever, ...
Leukocyte alkaline phosphatase activity greater than 250 U/L

Block 2/Question#25
A 44-year-old man with invasive pancreatic cancer is brought ...
Area labeled ‘H’

Block 2/Question#26
A 36-year-old woman comes to the physician for a follow-up ...
Fibromuscular dysplasia

Block 2/Question#27
A 3-month-old girl is brought to the physician by her parents ...
Densely packed capillaries

Block 2/Question#28
A cohort study is conducted to examine the association ...

Block 2/Question#29
Which of the following pairs of drugs interferes with DNA ...
Lomustine and cyclophosphamide

Block 2/Question#30
A 21-year-old man is brought to the emergency department 30 ...

Block 2/Question#31
A 40-year-old man has had enlarging breast tissue for the ...

Block 2/Question#32
A 2-year-old girl is brought to the physician because she is ...
N-methyl-d-aspartate (NMDA)

Block 2/Question#33
A 68-year-old man who has been treated for the past 4 weeks ...
Area labeled ‘B’

Block 2/Question#34
A 35-year-old woman comes to the physician because of a ...
Synthesis of viral DNA

Block 2/Question#35
A 42-year-old man with a history of recurrent pyelonephritis ...
Magnesium ammonium phosphate

Block 2/Question#36
A newborn has external genitalia that appear to be male. ...
Hyperplastic fetal adrenal glands

Block 2/Question#37
A 62-year-old woman is brought to the physician because her ...
Embolus to the femoral artery with left leg ischemia

Block 2/Question#38
A 78-year-old man is found unresponsive in his yard by a ...
"Thank you for telling me this. Your friend's previous statements to you can be helpful in making decisions for him."

Block 2/Question#39
A 39-year-old woman with obesity and recently diagnosed ...

Block 2/Question#40
A 22-year-old man is brought to the emergency department 30 ...
Peak inspiratory pressure (alveolar): positive;
End-tidal pressure (alveolar): positive;
Peak inspiratory pressure (intrapleural): positive;
End-tidal pressure (intrapleural): positive

Block 2/Question#41
A 44-year-old woman, gravida 2, para 2, comes to the ...
Cervical canal

Block 2/Question#42
A 63-year-old woman comes to the physician because of a ...
FVC: decreased;
FEV1/FVC: decreased;
Peak expiratory flow rate: decreased;
Peak inspiratory flow rate: decreased

Block 2/Question#43
A 2-week-old girl is brought to the physician by her parents ...

Block 2/Question#44
A 4-year-old boy is brought to the physician by his parents ...
Dietary change

Block 2/Question#45
A 61-year-old man is prescribed fluoxetine for major ...
Raphe nuclei

Block 2/Question#46
Which of the following types of vaccine is most appropriate ...
Live attenuated virus

Block 2/Question#47
A 65-year-old man is scheduled for physical therapy 3 days ...
Medial (internal) rotation

Block 2/Question#48
A 45-year-old woman is brought to the emergency department ...
Inspiratory pause on right upper quadrant palpation

Block 2/Question#49
A 56-year-old man comes to the physician because of severe ...

Block 2/Question#50
A 65-year-old man recovering from a cerebral infarction due ...
Preventing ADP-stimulated platelet activation

Block 3/Question#1
A 32-year-old woman comes to the physician after the result ...
Yolk sac

Block 3/Question#2
A 35-year-old man comes to a new physician for a health ...

Block 3/Question#3
An 18-hour-old male newborn is 61 cm (24 in) long and weighs ...
Decreased gluconeogenesis

Block 3/Question#4
A 31-year-old primigravid woman at 32 weeks' gestation comes ...

Block 3/Question#5
A 68-year-old woman has a 6-month history of weakness, ...
Na+: decreased;
K+: increased;
pH: decreased

Block 3/Question#6
A 25-year-old man has an orchiectomy for a recently detected ...
Germ cells

Block 3/Question#7
A male newborn is delivered at 39 weeks' gestation after an ...

Block 3/Question#8
A 62-year-old man with a blood pressure of 220/160 mm Hg ...

Block 3/Question#9
A male newborn is delivered at term to a 30-year-old woman. ...
Ask the mother and sister to leave the room and inform the parents of the abnormality

Block 3/Question#10
An investigator is studying two drugs, Drugs X and Y, to ...
Area under the curve

Block 3/Question#11
A 50-year-old woman with idiopathic cardiomyopathy is ...
Penetration of larvae from soil into the skin

Block 3/Question#12
A 39-year-old man comes to the physician for a routine health ...

Block 3/Question#13
A 65-year-old man with a history of gout comes to the ...
I will authorize the permit, but I recommend that you continue with regular exercise and only use the permit when you are having severe pain.

Block 3/Question#14
A 3-day-old male infant with Down syndrome has had repeated ...
Duodenal atresia

Block 3/Question#15
A 45-year-old woman comes to the physician for a follow-up ...

Block 3/Question#16
A 40-year-old woman comes to the physician because of a ...
Pituitary gland

Block 3/Question#17
A 24-year-old woman comes to the physician because of a ...
Accessory spleen

Block 3/Question#18
A patient with a 20-year history of type 1 diabetes mellitus ...
Impaired release of glucagon

Block 3/Question#19
A previously healthy 32-year-old man is brought to the ...
Toxicology screening

Block 3/Question#20
An 82-year-old woman is brought to the physician by her ...
Decreased function of the puborectalis muscle

Block 3/Question#21
A 60-year-old woman comes to the physician 1 week after she ...

Block 3/Question#22
A 54-year-old woman with rheumatic heart disease is brought ...
Intra-alveolar transudates

Block 3/Question#23
A pregnant 28-year-old woman is found to have symmetrical ...

Block 3/Question#24
A 25-year-old man is brought to the emergency department 30 ...
Fractional excretion of sodium greater than 2%

Block 3/Question#25
A 43-year-old woman undergoing chemotherapy for acute ...
Preformed IgM antibodies

Block 3/Question#26
A 27-year-old woman has headaches and blurred vision. She ...

Block 3/Question#27
A 30-year-old man reports increasing fatigue and dyspnea on ...
Atrial septal defect

Block 3/Question#28
A 10-year-old boy sustains an abrasion on his left knee. One ...
Labile cells

Block 3/Question#29
A 50-kg (110-lb) experimental animal receives 1 L of 5% ...
Intracellular volume: decreased;
Intracellular osmolality: increased;
Extracellular volume: increased;
Extracellular osmolality: increased

Block 3/Question#30
A 20-year-old woman comes to the physician because of a ...

Block 3/Question#31
The parents of a 1-year-old boy with a bilateral cleft palate ...

Block 3/Question#32
A 70-year-old man comes to the physician because of decreased ...
Inhibition of prostaglandin synthesis

Block 3/Question#33
A 78-year-old man has had progressive loss of hearing in his ...

Block 3/Question#34
A 34-year-old woman with a long-standing history of ...

Block 3/Question#35
A 31-year-old woman comes to the emergency department because ...
Tell the patient's husband that he is not allowed in the treatment area, and that he must remain in the waiting area

Block 3/Question#36
A 70-year-old woman comes to the physician because of a ...
Serum sickness

Block 3/Question#37
A 48-year-old man is referred for evaluation of possible ...
108 to 118

Block 3/Question#38
A 5-year-old boy who has recently recovered from an upper ...
Immune destruction of platelets

Block 3/Question#39
A 44-year-old woman comes to the physician because of a ...
Decreased CSF production by the choroid plexus

Block 3/Question#40
A 38-year-old woman with hypercalcemia, hypophosphatemia, and ...
Area labeled ‘B’ (Proximal convoluted tubule)

Block 3/Question#41
A previously healthy 45-year-old man comes to the physician ...

Block 3/Question#42
A 48-year-old woman has severe gastroesophageal reflux. ...
Inhibition of gastric H+–K+ ATPase

Block 3/Question#43
A 65-year-old man has had increasing shortness of breath over ...
Osteitis deformans (Paget disease)

Block 3/Question#44
A 23-year-old woman comes to the physician for advice ...
Because irradiated food is not radioactive, you will not be exposed to ionizing radiation by consuming it.

Block 3/Question#45
A 44-year-old woman comes to the physician because of a ...
Decreased arterial Pco2

Block 3/Question#46
A 19-year-old woman is severely burned over 35% of her total ...
Increased metabolic rate

Block 3/Question#47
A 14-year-old boy with a tibial fracture is fitted with a leg ...
Neck of the fibula

Block 3/Question#48
A 20-year-old woman comes to the physician because of a ...
Inhibition of the cytochrome P450-dependent demethylation reaction

Block 3/Question#49
Genetic analyses of cells obtained on amniocentesis confirm ...

Block 3/Question#50
A 32-year-old woman, gravida 2, para 1, at 39 weeks' ...
Increased fetal systemic vascular resistance

Block 4/Question#1
A 65-year-old man is brought to the emergency department ...
Thromboxane A2

Block 4/Question#2
A 60-year-old woman with type 2 diabetes mellitus comes to ...
Subacromial bursitis

Block 4/Question#3
A 33-year-old woman comes to the physician for a routine ...
Inorganic phosphorus: decreased;
Parathyroid hormone: increased;
Calcitriol: decreased

Block 4/Question#4
A 76-year-old woman is brought to the physician by her son ...
She expresses clear and consistent values

Block 4/Question#5
Transmission of a bacterial agent by person-to-person contact ...
Meningococcal meningitis

Block 4/Question#6
A 35-year-old woman, gravida 2, para 1, undergoes vaginal ...
External anal sphincter

Block 4/Question#7
A 3-day-old female newborn delivered at term is brought to ...
Increased conversion of bilirubin to water-soluble isomers

Block 4/Question#8
A 36-year-old nulligravid woman and her 40-year-old husband ...
1 of 50

Block 4/Question#9
A 35-year-old man who is a veterinarian in a rural area comes ...
Coxiella burnetii

Block 4/Question#10
A study was conducted to investigate the mean age at onset in ...

Block 4/Question#11
A 40-year-old man comes to the physician for a routine health ...

Block 4/Question#12
Investigators conduct a prospective, community-based study to ...
Strength of association, temporal relationship, dose-response gradient

Block 4/Question#13
A 65-year-old man comes to the physician because of a 1-year ...
Smooth muscle cells of the deep artery

Block 4/Question#14
A 61-year-old woman comes to the physician for a health ...
Closure of the mitral valve

Block 4/Question#15
A 35-year-old man comes to the physician because of a 4-month ...
Arachidonic acid

Block 4/Question#16
In a study of the use of ultrasonography for the early ...

Block 4/Question#17
A 24-year-old man has a grade 3/6 systolic murmur. Cardiac ...
Aortic stenosis

Block 4/Question#18
An investigator is conducting a study to determine the cause ...

Block 4/Question#19
A 6-month-old male infant is brought to the physician because ...
Regulatory T lymphocytes

Block 4/Question#20
A 7-year-old boy is brought to the physician by his mother ...
Release of interferon gamma by TH1 cells

Block 4/Question#21
An otherwise healthy 26-year-old scuba diver has difficulty ...
Hyperresonance over most of the left side of the chest

Block 4/Question#22
A 40-year-old man with terminal small cell carcinoma of the ...

Block 4/Question#23
A 74-year-old woman comes to the physician because of a ...

Block 4/Question#24
A 60-year-old man comes to the physician because of a 1-month ...

Block 4/Question#25
An 85-year-old woman is brought to the physician by her ...

Block 4/Question#26
A 28-year-old man has hypertriglyceridemia that has not ...

Block 4/Question#27
A man accidentally touches the surface of a hot stove; 20 ...

Block 4/Question#28
An 18-month-old girl is brought to the physician because of ...
Decreased sodium bicarbonate reabsorption in the proximal tubule

Block 4/Question#29
A 2-week-old male newborn is brought to the physician by his ...
Galactose-1-phosphate uridyltransferase

Block 4/Question#30
A study is planned to assess differences in hypertension ...
Cross-sectional study

Block 4/Question#31
A 32-year-old man who lives at sea level travels to a ...

Block 4/Question#32
A 42-year-old woman comes to the office because of a 1-year ...
Spontaneous regression

Block 4/Question#33
A 16-year-old girl with bulimia nervosa is brought to the ...
Potassium: decreased;
Chloride: increased;
Bicarbonate: decreased

Block 4/Question#34
A 44-year-old man who is a farmer and has been spraying his ...
Area labeled ‘D’

Block 4/Question#35
A 17-year-old girl with type 1 diabetes mellitus comes to the ...
Acknowledge the patient's reasons for missing insulin injections

Block 4/Question#36
A 40-year-old man comes to the physician because of a 3-month ...

Block 4/Question#37
A 2-year-old boy is brought to the emergency department ...
Lipoprotein lipase

Block 4/Question#38
A 45-year-old woman is scheduled to undergo a lymph node ...
Accompany the resident while the resident obtains signed consent

Block 4/Question#39
A 44-year-old woman comes to the physician because of ...
Celiac sprue

Block 4/Question#40
A 16-year-old girl is brought to the emergency department 30 ...
Tail of the pancreas

Block 4/Question#41
Electrophysiology of the heart is studied in an anesthetized ...
Ablation of the atrioventricular node

Block 4/Question#42
A 12-year-old girl is admitted to the hospital for treatment ...

Block 4/Question#43
A 65-year-old man develops a progressive ataxia with gait ...
Right cerebellar hemisphere

Block 4/Question#44
A 44-year-old man is brought to the emergency department by ...
Entrapment of the inferior rectus muscle

Block 4/Question#45
A 32-year-old man has a diastolic blood pressure that ...
Precapillary resistance

Block 4/Question#46
A female neonate is delivered at 38 weeks' gestation by ...
Rough endoplasmic reticulum

Block 4/Question#47
A 43-year-old woman comes to the physician because she has ...
Left atrial myxoma

Block 4/Question#48
A 2-week-old female newborn of Mexican descent is brought to ...
Why don't you continue with what you're doing, and let's try changing her to a different formula.

Block 4/Question#49
A 15-year-old boy is brought to the physician for a ...

Block 4/Question#50
A 48-year-old man has complete loss of hearing in his right ...
Area labeled ‘C’ (Cranial nerve 8: vestibulocochlear)

Recent comments ...

... sajaqua1 made a comment on nbme23/block1/q#44 (A 34-year-old woman is brought to the emergency...)
 +33  upvote downvote
submitted by sajaqua1(389)

A and J represent the gracile fasciculus, while B and I represent the cuneate fasciculus. Together they make up the dorsal column-medial lemniscal tract, responsible for pinpoint perception, proprioception, vibration, and pressure. Input is ipsilateral.

C and H make up the lateral corticospinal tract (also called the lateral cerebrospinal fasciculus), responsible for motor command of ipsilateral limbs.

D and G represent the lateral spinothalamic tract. It is responsible for pain and temperature conduction. The input arises in a limb (left lower extremity in this case), enters through the dorsal root (pictured between J and H), decussates and ascends at the anterior commissure (just behind E and F), and finally synapses on the second order neuron in the lateral spinothalamic tract. So the spinothalamic tract is responsible for contralateral pain and temperature sensation. Because our patient has lost sensation on the left, the lesion is in the right.

E and F are the anterior corticospinal tract. It is involved in motor control of proximal muscles, typically of the trunk.

nor16  good job
... ferrero made a comment on nbme23/block4/q#45 (A 32-year-old man has a diastolic blood pressure...)
 +30  upvote downvote
submitted by ferrero(32)

A very similar question I have seen in Qbanks will ask why a patient with right heart failure does not develop edema and the answer is increased lymphatic drainage. I got this question wrong originally because I answered along this line of reasoning but I think in this case it all has to do with WHERE the extra pressure is coming from. In this question the pt has diastolic hypertension so you can think about the pressure as coming "forward" so constricting precapillary sphincters can prevent an increase in pressure in the capillary bed. However for right heart failure this extra fluid is coming from the OPPOSITE direction (backwards from the right heart) and constricting precapillary sphincters can do nothing (on opposite side of capillary bed) - the only way to prevent edema is to increase lymphatic drainage.

seagull  The question clearly lead us to think about Osmotic pressure by talking about protein and urine. I wonder how many people used that line of reasoning (like myself)?
mousie  Great explanation, I chose lymphatic drainage for the same reasoning (similar Q on different bank)
sympathetikey  My reasoning was much more simplistic (maybe too simple) but in my mind, systolic BP is determined by Cardiac Output and diastolic BP is determined by arterioles. Therefore, what comes before the capillary and regulates resistance? Arterioles. That's why I said that pre-capillary resistance.
cr  the main difference between the 2 cases is that in this case the patient has high BP
link981  So in kindergarten language the question is essentially asking how high pressure in the arterial system is NOT transmitted to the venous system (which is where EDEMA develops). But you know they have to add all this info to try confuse a basic principle and make you second guess yourself. (Got it wrong by the way) because of what @ferrero said of Qbank questions.
hello  @ferrero what are you talking about? lymphatic drainage is the wrong answer...
hello  ok never mind. i got it. hard to understand b/c it was a big block of text.
asteroides  I think they may be talking about the myogenic compensatory mechanism: https://www.ncbi.nlm.nih.gov/books/NBK53445/figure/fig4.1/?report=objectonly "Increased arterial or venous pressure also induces myogenic constriction of arterioles and precapillary sphincters, which raises arteriolar resistance (thereby minimizing the increase in capillary pressure) and reduces the microvascular surface area available for fluid exchange. For example, because vascular smooth muscle in arterial and arteriolar walls contracts when exposed to elevated intravascular pressures, this myogenic response increases precapillary resistance and protects capillaries from a concomitant rise in their intravascular pressure."
... hayayah made a comment on nbme23/block2/q#43 (A 2-week-old girl is brought to the physician by her...)
 +29  upvote downvote
submitted by hayayah(883)

Coloboma is an eye abnormality that occurs before birth. They're missing pieces of tissue in structures that form the eye.

  • Colobomas affecting the iris, which result in a "keyhole" appearance of the pupil, generally do not lead to vision loss.

  • Colobomas involving the retina result in vision loss in specific parts of the visual field.

  • Large retinal colobomas or those affecting the optic nerve can cause low vision, which means vision loss that cannot be completely corrected with glasses or contact lenses.

mousie  thanks for this explanation!
macrohphage95  can any one explain to me why not lens ?
krewfoo99  @macrophage95 Lens are an interal part of the refractive power of the eye. Without the lens the image would not be formed on the retina, thus leading to visual loss
qfever  Do anyone know why not choroid?
adong  @qfever, no choroid would also be more detrimental to vision since it supplies blood to the retina
irgunner  That random zanki card with colobomas associated with a failure of the choroid fissure to close messed me up
mnemonicsfordayz  Seems like the key to this question is in what is omitted from the question stem: there is no mention of vision loss. If we assume there is no vision loss, then we can eliminate things associated with visual acuity (weird to think of in 2 week old but whatever): C, D, E, F. Also, by @hayayah 's reasoning, we eliminate E & F. If you reconsider the "asymmetric left pupil" then the only likely answer between A & B is B, Iris because the iris' central opening forms the pupil. I mistakenly put A because I was thinking of the choroid fissure and I read the question incorrectly - but it's a poorly worded question IMO.
... yotsubato made a comment on nbme23/block4/q#10 (A study was conducted to investigate the mean age at...)
 +27  upvote downvote
submitted by yotsubato(644)

Was it just me, or did "age at onset in years" appear RIGHT above the number of patients, rather than the mean. Which confused me for a good 3 minutes.

fulminant_life  Definitely was the same for me. I was so confused for like 5 mins
d_holles  dude i almost didn't get the question bc of this ... i thought the age of onset was the actual age of onset (36)
mellowpenguins  Are you serious. NBME strikes again with shitty formatting.
yex  OMG!! Now I just realized that. Super confused and also thought onset of age was 36. :-/
monkey  what is 36 supposed to be?
thomasburton  Think the number of people in that group
paulkarr  Yup...was looking at it for a good 3 min before just doing the "fuck it..it's gotta be 99"
arcanumm  Age of Onset is the Title of the table, which I didn't figure out until after exam was over. What terrible formatting.
... sne made a comment on nbme23/block1/q#3 (A 52-year-old man comes to the physician because of...)
 +24  upvote downvote
submitted by sne(26)

Alcoholic = pancreatic insufficiency. Linoleic, oleic, and palmitic acid can be absorbed without pancreatic lipases since they're just free fatty acids. Triglycerides need to be broken down by lipases before absorption.

Bile acids are the main method for eliminating cholesterol, not pancreatic enzymes

rina  also palmitic acids are fats that are synthesized de novo in the human body for storage so it wouldn't make sense to poop them out
... seagull made a comment on nbme23/block4/q#50 (A 48-year-old man has complete loss of hearing in...)
 +24  upvote downvote
submitted by seagull(839)

What a terrible picture. They they covered up part of it with lines. WTF

sympathetikey  Agreed.
catch-22  Start at the pontomedullary junction and count from superior to inferiorly (or medially to laterally): VI, VII, VIII, IX.
yotsubato  I looked at the left side (cause the nerves arent frazzled up). Saw 7 and 8 come out together nicely. Then picked the right sided version of 8
lolmedlol  why is it not H or I on the right side; the stem says he has hearing loss on the right side, so the lesion should be ipsilateral no?
catch-22  You're looking at the ventral aspect of the brainstem.
catch-22  ^Also, you know it's the ventral aspect because you can see the medullary pyramids.
amarousis  think of the belly of the pons as a pregnant lady. so you're looking at the front of her
hello  which letter is CN IX in this diagram?
miriamp3  there is no VI nerve. That's the thing. The VI nerve should be in the angle between the pons and the medulla. Parallel to the pyramid. It goes V then VII and then VIII. I make the same mistake and I thought it was the picture but there is no VI par in the photo. They know We count from superior to inferior.
jesusisking  Don't G and H lowkey look like VII and VIII? I chose H b/c of that
ljennetten  G and H are CN VII and VIII on the left side, while this guy has right sided hearing loss. CN VI is not labeled in this photo, but is the smaller nerve that arises medial to CN VII and us cut most of the way up the pons.
... soph made a comment on nbme23/block2/q#40 (A 22-year-old man is brought to the emergency...)
 +23  upvote downvote
submitted by soph(44)

you need to know diff bt negative pressure ventilation (which is normal ventilation) and positive presssure ventilation (which is mechanical ventilation). In negative pressrue ventilation the diaphragm contracts making a - intrapleural pressure which allows alveoli to expand. in positive ventilation (the pt diaphragm is not contracting thus not expanding chest cavitiy and not creating the - pressure) the machine is creating positive pressure inside alveoli so so alveoli expands. :)

... wired-in made a comment on nbme23/block2/q#15 (A child with septicemia has an antibiotic clearance...)
 +21  upvote downvote
submitted by wired-in(48)

Maintenance dose formula is (CssCltau)/F where Css is steady-state target plasma conc. of drug, Cl is clearance, tau is dosage interval & F is bioavailability.

Neither dosage interval nor bioavailability is given, so ignoring those & plugging in the numbers (careful to convert units to mg/kg/day): (12 ug/mL * 1 mg/1000 ug) * (0.09 L/hr/kg * 1000 mL/1 L * 24 hr/1 day) = 25.92 mg/kg/day

...which isn't any of the answer choices listed. They must have rounded 0.09 L/hr/kg to 0.1 L/hr/kg, and doing so gives exactly 28.8 mg/kg/day (choice C)

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong
hyoid  ^^^^^
seagull  lol..my math never worked either. I also just chose the closest number. also, screw this question author for doing that.
praderwilli  Big mad
ht3  this is why you never waste 7 minutes on a question.... because of shit like this
yotsubato  Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways...
bigjimbo  JOKES
cr  in ur maths, why did u put 24h/1day and not 1day/24h? if the given Cl was 0.09L/hr/kg. I know it just is a math question, but i´d appreciate if someone could explain it.
d_holles  LMAO games NBME plays
hyperfukus  magic math!!!!! how TF r we supposed to know when they round and when they don't like wtf im so pissed someone please tell me step isn't like this...with such precise decimal answers and a calculator fxn you would assume they wanted an actual answer!
jean_young2019  OMG, I've got the 25.92 mg/kg/day, which isn't any of the answer choices listed. So I chose the D 51.8, because 51.8 is double of 25.9......I thought I must have make a mistake during the calculation ......
atbangura  They purposely did that so if you made a mistake with your conversion like I did, you might end up with 2.5 which was one of the answer choices. SMH
titanesxvi  I did well, but I thought that my mistake was something to do with the conversion and end up choosing 2.5 because it is similar to 25.92
makinallkindzofgainz  The fact that we pay these people 60 dollars a pop for poorly formatted and written exams boggles my mind, and yet here I am, about to buy Form 24
qball  Me after plugging in the right numbers and not rounding down : https://i.kym-cdn.com/entries/icons/original/000/028/539/DyqSKoaX4AATc2G.jpg
frustratedllama  Not only do you feel like you're doing sth wrong but then that feeling stays for other questions. sucks so baad
fexx  'here.. take 50mg of vyvanse.. I just rounded it up from 30.. dw you'll be fine' (totally doing this with my patients 8-))
... sajaqua1 made a comment on nbme23/block1/q#25 (A 5-year-old boy who is undergoing induction...)
 +21  upvote downvote
submitted by sajaqua1(389)

Critical points for this question: 5 year old boy, immunosuppressed because of chemotherapy, 2 day history of fever, cough, shortness of breath, febrile (101.8 F), respirations 46/min, with cyanosis and generalized vesicular rash. Extensive nodular infiltration.

Of the options listed only measles and VZV give a rash. A rash from measles usually starts rostrally and descends caudally, and is flat and erythematous. By contrast, VZV (chickenpox) presents with generalized rash that quickly transitions from macular to papular then to vesicular.

sympathetikey  Good call.
imnotarobotbut  Also, VZV causes pneumonia (what this patient probably had) and encephalopathy in the immunocompromised.
nwinkelmann  What threw me off was that it didn't mention the synchronicity of the rash. I stupidly took failure to mention to mean that the rash was synchronous, which doesn't fit VZV because chickenpox rash is characterized as a dyssynchronous rash (i.e. all stages of the macule to papule to vesicle to ulceration are seen at the same time). MUST REMEMBER: don't add information not given!
jboud86  If anyone wants to refresh info on Vaicella-Zoster virus, page 165 in FA 2019.
... beeip made a comment on nbme23/block1/q#35 (A 42-year-old woman comes to the physician because...)
 +21  upvote downvote
submitted by beeip(104)

The best I can understand, they're describing endometrial hyperplasia, a result of excess estrogen, a steroid hormone that translocates to the nucleus and binds its transcription factor.

mousie  My exact thinking also!
sympathetikey  Ditto.
meningitis  My thought as well but the answer says: "Binding of ligand to Nuclear transcription factor" and I thought to myself: "Estrogen Receptors aren't transcription factors.. they are receptors with Transcription Factor function that bind to the ER Element and recruit more Transcription Factors". Can anyone explain what I am missing? Am overthinking things?
criovoly  You are overthinking it, Steroid hormones receptor is found intracellular in the cytoplasm then they are translocated to the nucleus where they regulate gene transcription. HOPE THIS HELPS
eve1000  Could this be due to the PTEN gene being linked to endometrial hyperplasia?
feochromocytoma  The question stem says it's glandular hyperplasia "without" atypia It's just due to increased levels of estrogen causing the hyperplasia
... yotsubato made a comment on nbme23/block3/q#48 (A 20-year-old woman comes to the physician because...)
 +21  upvote downvote
submitted by yotsubato(644)

So for Candida we can use

Azoles (fluconazole) (inhibit CYP450 demethylation)

Amphotercin B (pore formation in fungal cell membrane)

Caspofungin (prevent crosslinking of beta glucans in cell wall)

or Nysatin for oral or esophageal cases (pore formation)

This question is saying that she is taking an ORAL drug to treat candida vaginitis.

Amphotercin is IV

Caspofungin is also IV

so we're left with azoles

Azoles inhibit synthesis of ergosterol by inhibiting CYP 450 that converts lanosterol to ergosterol.

qball  Nystatin does treat vaginal candidiasis but is TOPICAL.
thotcandy  Nystatin is NOT for esophageal candidiasis, Swish and spit, not swallow.
staghorn  Me - picks Metronidazole -_-
alexxxx30  @thotcandy...actually you can swish and swallow nystatin for esophageal infections (per Sketchy micro candida sketch)
turtlepenlight  I have seen that on the wards so I hope it works!
fexx  and my smartass picks amphp B
... seagull made a comment on nbme23/block4/q#28 (An 18-month-old girl is brought to the physician...)
 +20  upvote downvote
submitted by seagull(839)

This is a type II Renal Tubular Acidosis. My Medical School Never taught this to me. Did you also go to poverty med school? I'm surprised they even gave us toilet paper.

mousie  haha mine didn't either. But they usually leave out most high yield info so, to be expected I guess.
yotsubato  I didnt have physiology in my medical school. None, zip, zero, none. Nor did I have biochem. They said "you learned all this shit in undergrad, youll memorize it again for step 1 and forget it promptly" and then just moved on.
jcmed  In the Caribbean thats 1 thing we were given... lots and lots of toilet paper
... thomasalterman made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
 +19  upvote downvote
submitted by thomasalterman(122)

Malaria can impair hepatic gluconeogenesis and can also consume glucose for its own metabolic demands.

yotsubato  Truly a bull shit question... Its not in FA, Sketchy or Pathoma
meningitis  I will try to remember this by associating it with P. vivax, that stay in the liver (liver=gluconeogenesis). Thank you @thomasalterman.
focus  ADDITIONAL INFO: If we were asked to identify the stage of the lifecycle, it would be (intra-erythrocytic) schizont stage: https://labmedicineblog.files.wordpress.com/2018/06/mal3.jpg?w=840 Life-cycle: https://www.cddep.org/wp-content/uploads/2017/06/malaria-life-cycle_4-1440x1080.jpg
dul071  i solved this question by seeing that there are hemolytic inclusions resembling parasites and that they require glucose being a living organism, hence hypoglycemia.
... hayayah made a comment on nbme23/block1/q#11 (A 55-year-old man who has a 10-year history of type...)
 +18  upvote downvote
submitted by hayayah(883)

He has fecal incontinence so his external sphincter is damaged, which is innervated by the pudendal n. (S2-S4). The pelvic splanchnic nerves, which mediate the erection process, are also S2-S4.

thomasburton  Why could this not be dysuria?
lilyo  I think that you are thinking about urinary incontinence. If we damage the pudendal nerve S2-S4, you can exhibit urinary and fecal incontinence since this nerve innervates both the urethral and the external anal sphincters. However since the pelvic splanchnic nerves also have roots that originate in S2-S4 a patient with pudendal nerve damage will also have impotence since these control the erection reflex. He wouldn't have dysuria which is painful urination. Most likely caused by a urethral infection or a blockade of the urinary tract. He would have urinary incontinence. I hope this helps.
alexxxx30  dysuria is painful urination...if it said urinary incontinence then you'd be right. But decreased innervation wouldn't cause pain (that would mores be associated with UTI)
peqmd  Another approach is fecal incontinence => parasympathetic nerve dysfunction => no boner
dul071  ahhhhh fucked up with terminology again thinking dysuria was urinary incontinence
... colonelred_ made a comment on nbme23/block2/q#28 (A cohort study is conducted to examine the...)
 +18  upvote downvote
submitted by colonelred_(79)

Attributable risk = incidence in exposed – incidence in unexposed

= 30/1,000 (smokers) - 30/3,000 (nonsmokers)
= 0.03 - 0.01
= 0.02 (so the attributable risk is about 2%)

Applying it to a population of 10,000:

= 0.02 * 10,000
= 200

charcot_bouchard  What if i tell you this is a ques of Attributable risk % in exposed? AR= 0.02 / IR in exposed (30/1000) = 0.6667 30 case in 1000. So 300 case in 10,000 0.6667 x 300 = 200 or in another word 66% cases of 100 lung cancer cases in smokers is actually due to smoking. so in 300 cases of smokers 200 is actually due to smoking
charcot_bouchard  This is a mind fuck. Lemme tell u guys if any consolation while doing the ques during test i did it with AR = 0.02; NNH = 1/0.02 = 50. 50 persons smoke to cause 1 cancer. 10K smoke to cause 200 cancer.
ls3076  Sorry if this is a stupid question. Why is it incorrect to simply apply the same proportion (30 cancer per 1000 smokers) to 10,000 smokers?
krewfoo99  @is3076 Thats exactly what is did. I still dont understand how that is wrong. But i guess they want us to think about it in terms of AR
hhsuperhigh  @Is3076 and @Krewfoo99, If a person doesn't smoke, the natural risk of getting lung cancer is 30/3000=1%. The smoker's risk is 30/1000=3%. This 3% is not purely contributed by smoking, but mixed with the natural risk. So for calculating the pure contribution made by smoking, you should use 3%-1% which is 2%. And this 2% is the pure contribution of smoking. Not all smokers get lung cancer, the same thing, not all lung cancer among smokers are attributed by smoking. They may get lung cancer anyway despite smoking or not.
... stinkysulfaeggs made a comment on nbme23/block3/q#4 (A 31-year-old primigravid woman at 32 weeks'...)
 +18  upvote downvote
submitted by stinkysulfaeggs(62)

Did anyone else go down the: she's hypotensive so maybe she'll get waterhouse friderichsen syndrome because nothing else is making sense to me at this point??? route -

Turns out, severe malaria can cause cardiovascular collapse and hypotension.

shriya goyal  yes I answered it like that
redvelvet  me too :(
abigail  me three :(
yex  Me four :-/
link981  Slowly raising my hand as well
tinydoc  Sammmme
bullshitusmle  same here!!!:@
usmlecharserssss  patient has malaria with obvious picture and clinic, i answered because only thing associated with liver was hypoglycemia
aisel1787  me five(
myoclonictonicbionic  I was thinking that she is hypotensive which can cause an infarct of the pituitary (since pituitary is growing during pregnancy) and therefore she'd have secondary adrenal insufficiency.
alexxxx30  sammmeeeee
snripper  Dumbasses unite lmao
usmleaspirant2020  lol saaaaame!
usmleaspirant2020  lol saaaaame!
... water made a comment on nbme23/block2/q#44 (A 4-year-old boy is brought to the physician by his...)
 +18  upvote downvote
submitted by water(25)

surprisingly, I actually learned this from the Magic School Bus when I was a kid. That's the only reason I got this right. Thanks Ms. Frizzle! :D

paulkarr  She taught me more than my med school professors did...
... thomasalterman made a comment on nbme23/block1/q#21 (A 40-year-old woman with a history of low-grade...)
 +17  upvote downvote
submitted by thomasalterman(122)

She just completed the course of rituximab, which targets CD20 receptors. B-cell deficiency can predispose to bacterial infections.

b) BM failure is not associated with rituximab c) wrong d) wrong e) this occurs w/in 7-10 days of starting treatment, and would not occur after completing a 4-month course of rituximab.

meningitis  Forgot the time frame for Serum sickness and got it wrong.. thanks @thomasalterman
stinkysulfaeggs  Same. Crap.
... mousie made a comment on nbme23/block2/q#8 (An 8-year-old boy is brought to the physician by his...)
 +17  upvote downvote
submitted by mousie(135)

Marfanoid habitus + Mucosal neuromas + Neck mass = MEN 2B (PMM) Pheo, Medullary thyroid CA (Calcitonin secreting), mucosal neuromas

thotcandy  I knew it was MEN2B but forgot medullary ca of Thyroid is parafollicular/c cells which means Calcitonin, not T3/T4 Other answers: AntiThyroglobulin: Hashimoto's (or other thyroiditis) Dexamethasone suppression test: positive/suppressed in pituitary adenoma (acth secreting), negative/unresponsive in Adrenal hyperplasia/adenoma (suppressed by high dose) or ectopic acth (unresponsive to high dose) Serum TSH test: for papillary or follicular ca, thyroid adenomas are usually cold but could also cause HyperT TSHR antibodies: graves disease, hyperT
... sajaqua1 made a comment on nbme23/block1/q#42 (A 68-year-old woman comes to the office because of a...)
 +17  upvote downvote
submitted by sajaqua1(389)

The patient has a prior history of hysterectomy with bilateral salpingo-oophorectomy, and received external beam radiation to the pelvis. The patient now displays hydronephrosis and hydroureter, with distal ureteral narrowing bilaterally. The likeliest option is that we are seeing adhesions from previous surgery constrict the ureters, causing this.

E) Urothelial carcinoma (also called transitional cell carcinoma) is also a possibility. What makes this unlikely is the location: bilateral. The prior hysterectomy and bilateral salpingo-oophorectomy would leave scar tissue on both sides of the body, but the odds of urothelial carcinoma arising bilaterally are very slim.

A) The patient had a hysterectomy, so the odds of recurrent cervical carcinoma are also incredibly low. C) and D) Urethral condyloma and urethral transitional cell papilloma are in the wrong location to account for bilateral urethral narrowing with hydroureter.

stinkysulfaeggs  Great explanation - just one addition. The retroperitoneal fibrosis could also be a direct consequence of the external beam radiation. It's linked to both causes. Either way, it's a better fit than urothelial carcinoma (in retrospect).
spow  Why would the onset be 15 years later though?
drzed  I was thinking the same thing @spow. I had put urothelial carcinoma, thinking that a field defect would result in bilateral tumor.

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