NBME 24

Block 1/Question#1
A researcher hypothesizes that exposure to more than 50 μg/L ...
Case-control study

Block 1/Question#2
A 43-year-old woman with a 2-year history of labile ...
Unopposed α-adrenergic tone

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

Block 1/Question#4
A 28-year-old man with AIDS has fever, headache, and ...
Lungs

Block 1/Question#5
The 35-year-old woman indicated by the arrow has a family ...
X-linked recessive

Block 1/Question#6
A 57-year-old woman requires intubation in the intensive care ...
Acute lung injury

Block 1/Question#7
A 65-year-old woman comes to the physician because of blood ...
Cigarette smoking

Block 1/Question#8
A 24-year-old woman at 28 weeks' gestation is brought to the ...
Tremor

Block 1/Question#9
The graph shows expiratory pressure-volume curves that ...
Diffuse pulmonary fibrosis

Block 1/Question#10
A 75-year-old man is brought unconscious to the emergency ...
Atherosclerosis

Block 1/Question#11
A 55-year-old man with type 1 diabetes mellitus comes to the ...
Persistent activation of voltage-gated Na+ channels in the nociceptor

Block 1/Question#12
A 26-year-old man comes to the physician for a follow-up ...
Increased number of LDL receptors on hepatocytes

Block 1/Question#13
A 4-year-old boy is brought to the emergency department by ...
Proliferative glomerulonephritis

Block 1/Question#14
A thin 66-year-old man is brought to the emergency department ...
Urine osmolality > plasma osmolality

Block 1/Question#15
Results of a 5-year screening program for HIV infection in a ...
5%

Block 1/Question#16
A 32-year-old man is brought to the emergency department ...
Flexion at the distal interphalangeal joint

Block 1/Question#17
A 3-year-old boy is brought to the emergency department ...
Annular pancreas

Block 1/Question#18
A 34-year-old woman with a long history of rheumatoid ...
Tuberculous osteomyelitis

Block 1/Question#19
A 35-year-old man comes to the physician because of a 1-week ...
Cluster headache

Block 1/Question#20
Immediately after a spontaneous vaginal delivery, a full-term ...
Fusion of the sclerotomes

Block 1/Question#21
A 35-year-old woman comes to the physician because of a ...
Foramen cecum

Block 1/Question#22
A 50-year-old man undergoes surgical transection of the ...
Adductor brevis

Block 1/Question#23
A 50-year-old man comes to the physician because of diarrhea ...
Generalized malabsorption

Block 1/Question#24
A 6-year-old girl is brought to the office by her mother ...
Pediculus humanus capitis

Block 1/Question#25
A 7-year-old boy has metabolic acidosis and persistent ...
Area labeled ‘B’ (Proximal convoluted tubule)

Block 1/Question#26
An 80-year-old woman with poorly controlled type 2 diabetes ...
Hematocrit: decreased;
Serum parathyroid hormone: increased;
Serum calcitriol: decreased


Block 1/Question#27
A 10-year-old girl with a lifelong history of intermittent ...
Palpable right ventricular lift

Block 1/Question#28
A 32-year-old woman comes to the physician because of a 7-day ...
Eosinophils

Block 1/Question#29
An 80-year-old woman comes to the physician because of a ...
Determination of erythrocyte sedimentation rate

Block 1/Question#30
A 55-year-old man is brought to the emergency department ...
Pulmonary capillary wedge pressure: increased;
Cardiac output: decreased;
Systemic vascular resistance: increased


Block 1/Question#31
An experimental study is conducted to examine the function of ...
Post-translational modification

Block 1/Question#32
A 24-year-old man receives an injection of histamine in the ...
Increased lymph flow

Block 1/Question#33
A 3-month-old girl is brought to the emergency department by ...
Human papillomavirus

Block 1/Question#34
A 62-year-old man comes to the physician for a follow-up ...
Sotalol

Block 1/Question#35
A 1616-g (3-lb 9-oz) male newborn is delivered to a ...
Bronchopulmonary dysplasia

Block 1/Question#36
A 4-year-old girl is brought to the physician because of a ...
Villous atrophy

Block 1/Question#37
A 25-year-old woman at 16 weeks' gestation comes to the ...
Increased hepatic production of T4-binding globulin

Block 1/Question#38
A 37-year-old woman comes to the physician because of nausea ...
Borderline

Block 1/Question#39
A 40-year-old man with AIDS develops severe diarrhea that is ...
Somatostatin

Block 1/Question#40
A 26-year-old man and his 25-year-old wife come to the ...
One in four will have 25% β-globin function and may require occasional transfusions

Block 1/Question#41
A 32-year-old woman who is 20 weeks' pregnant has had ...
Misoprostol

Block 1/Question#42
A 68-year-old woman with acute myelogenous leukemia begins ...
Granulocyte-macrophage colony-stimulating factor

Block 1/Question#43
After completing 6 courses of chemotherapy for cancer of the ...
Doxorubicin

Block 1/Question#44
A 24-year-old man is brought to the office because of fever ...
Alteration in DNA gyrase

Block 1/Question#45
A 71-year-old man is brought to the emergency department ...
Area labeled ‘D’ (Posterior inferior cerebellar artery)

Block 1/Question#46
A 10-year-old girl is scheduled to undergo fixation of a ...
Succinylcholine

Block 1/Question#47
A 35-year-old man comes to the physician 1 week after he had ...
Increased serum angiotensin II concentration

Block 1/Question#48
A 70-year-old man is brought to the emergency department ...
Stroke volume: decreased;
Left ventricular end-diastolic volume: increased;
Cardiac output: decreased


Block 1/Question#49
A 58-year-old man is brought to the emergency department 1 ...
Ruptured spleen

Block 1/Question#50
An 11-year-old boy is brought to the emergency department by ...
Intracellular and extracellular dehydration

Block 2/Question#1
A 73-year-old woman has had easy fatigability for 2 years. ...
Failure of conversion of N5-methyltetrahydrofolate to tetrahydrofolate

Block 2/Question#2
A 45-year-old man comes to the physician because of ...
Oxygen saturation

Block 2/Question#3
A 13-year-old boy is brought to the physician by his mother ...
This will typically resolve within the next 12 to 18 months.

Block 2/Question#4
A 57-year-old man has had hoarseness and difficulty ...
Area labeled ‘F’

Block 2/Question#5
A 55-year-old man is diagnosed with coronary artery disease. ...
Decreased adherence

Block 2/Question#6
A 50-year-old woman is admitted to the hospital for ...
Factitious disorder

Block 2/Question#7
A 75-year-old man with a 10-year history of progressive renal ...
Hydrostatic pressure in Bowman space

Block 2/Question#8
A 17-year-old girl is brought to the hospital by ambulance 45 ...
Beneficence

Block 2/Question#9
In which of the following stages of the cell cycle are ...
G2

Block 2/Question#10
A 29-year-old man is brought to the emergency department ...
Lateral pterygoid

Block 2/Question#11
A public health consultant is contacted by a health ...
Regular exercise

Block 2/Question#12
An 80-year-old man is admitted to the hospital because of a ...
20

Block 2/Question#13
An 80-year-old woman, gravida 4, para 4, comes to the office ...
Damage to the rectovaginal septum

Block 2/Question#14
A 25-year-old man comes to the emergency department because ...
Heroin

Block 2/Question#15
An investigator is studying a new drug for the treatment of ...
Free radical formation

Block 2/Question#16
A 28-year-old man with chronic hepatitis C comes to the ...
HIV

Block 2/Question#17
A 68-year-old man comes to the physician because he is ...
Normal aging

Block 2/Question#18
A 68-year-old man has loss of pain and temperature sensations ...
Right dorsolateral medulla

Block 2/Question#19
A 70-year-old man comes to the physician because of a 1-year ...
Alveolar-arterial Po 2 difference

Block 2/Question#20
A 52-year-old man is admitted to the hospital for treatment ...
Granulation tissue

Block 2/Question#21
A 50-year-old woman with HIV infection comes to the physician ...
Zidovudine

Block 2/Question#22
A 3-month-old boy is brought to the physician because of ...
Peroxisomes

Block 2/Question#23
A 9-year-old boy who was adopted from an African country 2 ...
E

Block 2/Question#24
A 59-year-old man has repeated episodes of gouty arthritis ...
Probenecid

Block 2/Question#25
A 35-year-old African American man comes to the physician for ...
Palms

Block 2/Question#26
A 35-year-old man is brought to the emergency department ...
Catecholamine-mediated intracellular shifts of K+

Block 2/Question#27
A 47-year-old man comes to the physician because of recurrent ...
Monosodium urate

Block 2/Question#28
A 3-year-old boy with AIDS develops giant cell pneumonia 3 ...
Negative-stranded RNA

Block 2/Question#29
A 65-year-old woman with well-controlled type 2 diabetes ...
Atherosclerosis

Block 2/Question#30
A 35-year-old man with small cell carcinoma of the lung has ...
ACTH

Block 2/Question#31
A patient with cancer who is being treated with high-dose ...
Granulocyte colony-stimulating factor

Block 2/Question#32
A 35-year-old woman undergoes a left oophorectomy because of ...
Ureter

Block 2/Question#33
A 58-year-old man comes to the physician because of a 3-day ...
Escherichia coli

Block 2/Question#34
A 40-year-old man who goes horseback riding 3 to 4 times ...
Myositis ossificans

Block 2/Question#35
A 55-year-old woman comes to the physician because of a ...
Lower motoneurons

Block 2/Question#36
A 27-year-old woman comes to the physician for a follow-up ...
Transforming growth factor-β

Block 2/Question#37
In a culture of motile spore-forming bacteria, which of the ...
Irradiation with x-rays

Block 2/Question#38
A 65-year-old man comes to the physician because of ...
Paroxetine

Block 2/Question#39
A 3-year-old boy has short stature and extremities and a ...
Endochondral ossification

Block 2/Question#40
A 4-year-old boy has a 1-cm round midline mass just inferior ...
Tongue

Block 2/Question#41
A 56-year-old man who is admitted to the hospital for ...
Determine whether the patient has decision-making capacity

Block 2/Question#42
A 3-week-old female newborn is brought to the physician for a ...
The patient has another mutation that was not included in the previous analysis

Block 2/Question#43
A 35-year-old woman has difficulty urinating 2 days post ...
Parasympathomimetic stimulation

Block 2/Question#44
A 35-year-old man with quadriplegia develops a urinary tract ...
Area labeled ‘B’ (Proximal convoluted tubule)

Block 2/Question#45
A 2-year-old boy is brought to the physician because of ...
Peptide transporter (TAP)

Block 2/Question#46
In a study of drug action on neoplastic cells in culture, ...
Vincristine

Block 2/Question#47
A 73-year-old man has an incurable malignant neoplasm of the ...
Both legal and ethical

Block 2/Question#48
The breakdown of dipeptides and tripeptides to free amino ...
Intestinal mucosa

Block 2/Question#49
A 17-year-old girl comes to the physician because she has ...
Increased serum testosterone concentration

Block 2/Question#50
An obese 57-year-old man comes to the physician for a routine ...
Normal ciliated columnar epithelium replaced by normal squamous epithelium

Block 3/Question#1
A 3-year-old girl has a history of recurrent infections. In ...
NADPH oxidase

Block 3/Question#2
A 28-year-old man has a blood pressure cuff placed around his ...
Adenosine

Block 3/Question#3
A 37-year-old woman with HIV infection is brought to the ...
Nucleoside reverse transcriptase inhibitor

Block 3/Question#4
A 27-year-old man comes to the physician because he and his ...
Injections of gonadotropins

Block 3/Question#5
A 37-year-old man is admitted to the hospital because of ...
Autoimmune adrenalitis

Block 3/Question#6
A 43-year-old woman comes to the physician because of a ...
Alkaline phosphatase

Block 3/Question#7
A 21-year-old woman with asthma comes to the physician ...
Phase 3

Block 3/Question#8
A 37-year-old man who is a farmworker comes to the emergency ...
Synaptobrevin

Block 3/Question#9
A 43-year-old woman comes to the physician because of a ...
Metastatic carcinoma

Block 3/Question#10
Serum cholesterol concentrations are measured as part of a ...
16%

Block 3/Question#11
The pedigrees of patients with schizophrenia most closely ...
Diabetes mellitus, type 1

Block 3/Question#12
A 35-year-old woman with asthma comes to the emergency ...
Thiabendazole

Block 3/Question#13
An 83-year-old woman is brought to the physician by her ...
Discussion of the diagnosis with the patient privately

Block 3/Question#14
A cohort study is done to evaluate the association between ...
0.05 < p < 1.0

Block 3/Question#15
A 17-year-old girl has significant blood loss after being ...
δ-Aminolevulinate

Block 3/Question#16
An 18-year-old woman is brought to the physician because of ...
Respiratory acidosis

Block 3/Question#17
HOX genes play a role in embryogenesis through which of the ...
Regulation of transcription

Block 3/Question#18
A 55-year-old man with alcoholism is brought to the emergency ...
Competitive inhibitor

Block 3/Question#19
A 23-year-old primigravid woman at 22 weeks' gestation is ...
Ask the patient if she would allow the examination if her husband is present at all times

Block 3/Question#20
A 33-year-old woman comes to the physician because of a ...
Defect in a cell membrane anchor protein

Block 3/Question#21
A 7-year-old girl is brought to the emergency department (ED) ...
Factitious disorder imposed on another

Block 3/Question#22
A 32-year-old woman recently diagnosed with AIDS is at ...
Epstein-Barr virus-induced brain lymphoma

Block 3/Question#23
A 32-year-old woman comes to the physician because of pain ...
Buccinator

Block 3/Question#24
A 3-month-old boy is brought to the emergency department ...
Gluconeogenesis

Block 3/Question#25
An investigator is studying a new virus isolated from a ...
Coronavirus

Block 3/Question#26
A 54-year-old man with a myocardial infarction becomes ...
Decrease in intracellular ATP concentrations

Block 3/Question#27
A 27-year-old man who works from home as a software engineer ...
Avoidant

Block 3/Question#28
A 22-year-old man is brought to the emergency department 30 ...
Area labeled ‘E’ (Cerebellum, posterior lobe)

Block 3/Question#29
Drug X is given to a 25-year-old normal subject. This drug ...
Partial agonist at β-adrenergic receptors

Block 3/Question#30
A 38-year-old woman comes to the physician because of ...
Intraductal papilloma

Block 3/Question#31
A 65-year-old man is brought to the emergency department 30 ...
Systemic vascular resistance: increased;
Pulmonary vascular resistance: decreased;
Pulmonary capillary wedge pressure: increased


Block 3/Question#32
A 15-year-old girl is brought to the physician because of a ...
CD8+ T lymphocytes

Block 3/Question#33
A 12-year-old boy is brought to the physician by his mother ...
Nocturnal luteinizing hormone pulses

Block 3/Question#34
An otherwise healthy 35-year-old man sustains a fracture of ...
Decreased blood volume

Block 3/Question#35
A 4-year-old girl has a history of multiple bone fractures ...
Scar formation

Block 3/Question#36
A 1-month-old male newborn is brought to the physician for a ...
Tyrosine

Block 3/Question#37
A man accidentally touches the surface of a hot stove; 20 ...
Interendothelial gaps in venules

Block 3/Question#38
A 55-year-old man comes to the physician because of a 2-week ...
Serum free thyroxine (FT4): increased;
Serum free triiodothyronine (FT3): increased;
Thyroidal iodine uptake: decreased


Block 3/Question#39
A 34-year-old woman is brought to the emergency department 45 ...
Lunate

Block 3/Question#40
A 2-year-old boy is brought to the emergency department ...
Polysaccharide protein conjugate vaccine

Block 3/Question#41
A 30-year-old man develops tingling around the lips and mouth ...
Sodium

Block 3/Question#42
Which of the following terms best describes the fibrous ...
Lamins

Block 3/Question#43
A 35-year-old woman with a long-standing history of asthma ...
Infiltration of lymphocytes and monocytes

Block 3/Question#44
A 62-year-old man comes to the physician for a follow-up ...
Serum gastrin

Block 3/Question#45
A 59-year-old woman has a 10-year history of progressive ...
Neural crest cells

Block 3/Question#46
A 15-year-old girl with cystic fibrosis has a mutation in the ...
Endoplasmic reticulum

Block 3/Question#47
A 22-year-old woman comes to the physician for a follow-up ...
Intrauterine device

Block 3/Question#48
A 62-year-old man comes to the physician because of a 2-month ...
Phantom limb pain

Block 3/Question#49
A 20-year-old woman with asthma comes to the physician ...
Ask the roommate not to smoke in the apartment

Block 3/Question#50
A group of physicians submits a report to a medical journal ...
Case series

Block 4/Question#1
A 30-year-old woman comes to the physician for follow-up ...
Glycine and succinyl CoA

Block 4/Question#2
A full-term male newborn has lethargy, poor feeding, and ...
Enzymatic reaction labeled ‘C’

Block 4/Question#3
A 23-year-old woman is brought to the emergency department ...
Renal tubular acidosis

Block 4/Question#4
A 63-year-old woman develops flank pain, tachycardia, and ...
ABO incompatibility

Block 4/Question#5
A 45-year-old man comes to the physician because of a 3-day ...
Muscle biopsy

Block 4/Question#6
A 68-year-old woman comes to the physician because of a ...
Inferior mesenteric and superior mesenteric

Block 4/Question#7
A 3-year-old girl is brought to the physician for a ...
Spontaneous regression

Block 4/Question#8
A 1-week-old newborn is brought to the physician because of ...
Organic acid metabolism disorder

Block 4/Question#9
A 10-year-old boy who was adopted from the Democratic ...
Black fly

Block 4/Question#10
A 60-year-old woman is receiving cisplatin therapy for ...
Hyporeflexia

Block 4/Question#11
A 53-year-old woman comes to the physician because of a ...
Fixed cardiac output in spite of increased demand

Block 4/Question#12
A 25-year-old woman takes an overdose of barbiturates and is ...
Extubate the patient and discontinue mechanical ventilation; make no attempt to do cardiopulmonary resuscitation in case of cardiac or respiratory failure

Block 4/Question#13
A 90-year-old man has a 1-week history of constipation and ...
Incarcerated inguinal hernia

Block 4/Question#14
A new screening test for colon cancer is done in 86 patients ...
118/124 = 95%

Block 4/Question#15
A 15-month-old boy is brought to the physician by his mother ...
Migration

Block 4/Question#16
A 24-year-old woman who has diffuse toxic goiter (Graves ...
Phosphate: increased;
Parathyroid hormone: decreased;
25-hydroxyvitamin D: normal


Block 4/Question#17
A 63-year-old woman undergoes operative repair of a leaking ...
Decreased movement through the arachnoid villi

Block 4/Question#18
A 64-year-old man undergoes surgical repair of an abdominal ...
Artery of the ductus deferens

Block 4/Question#19
A 38-year-old woman, gravida 4, para 4, comes to the ...
Internal anal sphincter

Block 4/Question#20
Forty of 100 attendees at a company Christmas party develop ...
Vibrio parahaemolyticus

Block 4/Question#21
An otherwise healthy 45-year-old man comes to the office ...
Aphthous ulcers

Block 4/Question#22
A 45-year-old man is brought to the emergency department 2 ...
Renal calculi in the left ureter

Block 4/Question#23
At 2:00 am, after sleeping for 5 hours, a 32-year-old man ...
Phenylethanolamine N-methyltransferase

Block 4/Question#24
A 13-year-old girl who has a 6-year history of type 1 ...
Discuss further the impact of the patient's illness on the family

Block 4/Question#25
A 26-year-old man is brought to the emergency department 40 ...
Pericardial tamponade

Block 4/Question#26
A 10-year-old girl is brought to the physician by her mother ...
Ovarian Sertoli-Leydig cells

Block 4/Question#27
A 19-year-old man has had weakness of the muscles of his neck ...
Polyneuropathy

Block 4/Question#28
A clinical study is designed to evaluate the association of ...
10%

Block 4/Question#29
A 56-year-old man has a 3-year history of progressive memory ...
Presenilin

Block 4/Question#30
An investigator is studying an outbreak of Escherichia coli ...
Only cookies are independently associated with E. coli cases

Block 4/Question#31
In a study of antibiotic resistance, a strain of Escherichia ...
Conjugation

Block 4/Question#32
A 45-year-old man with hypercholesterolemia (LDL 260 mg/dL) ...
Increased synthesis of LDL receptors

Block 4/Question#33
A 12-year-old boy is brought to the physician by his mother ...
Inhalant abuse

Block 4/Question#34
A 55-year-old woman comes to the physician for a routine ...
Neuroendocrine cell

Block 4/Question#35
An investigator is conducting a study of a novel protein in ...
Basal keratinocyte:suprabasal keratinocyte

Block 4/Question#36
A 68-year-old woman comes to the emergency department 2 hours ...
Alendronate

Block 4/Question#37
A male newborn is delivered in the hospital at 40 weeks' ...
Ingestion of undercooked meat

Block 4/Question#38
A 33-year-old woman at 34 weeks' gestation has a grade 2/6 ...
Stroke volume

Block 4/Question#39
A 30-year-old woman comes to the physician because of a ...
Decreased afferent arteriolar resistance

Block 4/Question#40
A 25-year-old woman is brought to the emergency department by ...
Pulmonary capillary leakage

Block 4/Question#41
A 30-year-old man who is a migrant farm worker comes to the ...
Formation of hypnozoites

Block 4/Question#42
A 40-year-old man who recently immigrated to the USA from ...
Adenine

Block 4/Question#43
A 72-year-old woman with coronary artery disease comes to the ...
Neointima formation in the right coronary stent

Block 4/Question#44
A 71-year-old woman with non-Hodgkin lymphoma is diagnosed ...
Leucovorin

Block 4/Question#45
A 40-year-old woman with a 25-year history of type 1 diabetes ...
Secreted by the proximal tubule

Block 4/Question#46
A 22-year-old woman comes to the physician because of nausea ...
Pineal gland

Block 4/Question#47
A 40-year-old man comes to the physician because of a 6-month ...
HNPCC syndrome

Block 4/Question#48
A 55-year-old woman is brought to the physician by her ...
Posterior cerebral

Block 4/Question#49
A 27-year-old man sustains a spinal cord transection at C-8 ...
Penile stimulation

Block 4/Question#50
A 47-year-old man comes to the physician because of abdominal ...
Superior rectal vein

Recent comments ...

... lsmarshall made a comment on nbme24/block1/q#1 (A researcher hypothesizes that exposure to more than...)
 +5  upvote downvote
submitted by lsmarshall(88)

An experimental design or experimental study must have an intervention, by definition. Case-control studies are observational studies, not experimental. This question is technically incorrect. They wanted to amke a point that case-control studies are time and cost efficient since they don't require following patients over time or any resources besides reviewing/gathering information. Case series could not test this hypothesis.

Also, the wording "associated wit an increased risk" somewhat alludes to case-control studies only having the ability to find odds of an associations between exposure and outcome, but not establish causal relationship.

bigjimbo  classic nbme
... catch-22 made a comment on nbme24/block1/q#1 (A researcher hypothesizes that exposure to more than...)
 +0  upvote downvote
submitted by catch-22(4)

I woud do a retrospective cohort here. I don't think this question is correct and provides too little information to get the correct answer. "Time efficient" is the operant word here but they simply didn't consider that retrospective cohort would be a better design here as long as the variables are coded.

... xxabi made a comment on nbme24/block1/q#2 (A 43-year-old woman with a 2-year history of labile...)
 +0  upvote downvote
submitted by xxabi(41)

Starting beta blockers before alpha blockade in pheochromocytoma is contraindicated. Beta blockers cancel out the vasodilatory effect of peripheral beta-2 adrenoceptors, potentially leading to unopposed alpha-adrenoceptor stimulation → vasoconstriction → hypertensive crisis.

... lsmarshall made a comment on nbme24/block1/q#3 (A 52-year-old woman comes to the physician because...)
 +2  upvote downvote
submitted by lsmarshall(88)

The most direct path, and most likely path, for breast cancer to metastasize to the vertebra are the intercostal veins. This was on an earlier NBME test as well. Breast cancer will cause mixed, lytic and blastic lesions once in bone.

On an unrealated note; I finally came up with a decent way to remember lytic vs. blastic cancers in bone!

kIdneY and thYroId cause lYtIc

prostate > blastate > blastic

Two breasts > two types of lesions > B reast causes B oth

Two lungs > two types of lesions (depending on type of lung cancer)

small-cell lung > "small blasts"

non-small cell > lytic

... welpdedelp made a comment on nbme24/block1/q#4 (A 28-year-old man with AIDS has fever, headache, and...)
 +0  upvote downvote
submitted by welpdedelp(37)

Cryptococcal meningitis that is transferred through respiratory droplets

https://www.cdc.gov/fungal/global/cryptococcal-meningitis.html

... seagull made a comment on nbme24/block1/q#4 (A 28-year-old man with AIDS has fever, headache, and...)
 +0  upvote downvote
submitted by seagull(158)

https://en.wikipedia.org/wiki/Blastomycosis#/media/File:Blastomyces_dermatitidis_GMS.jpeg

I believe this is actually disseminated Blastomyces due to the "Broad Based Budding" as seen in the picture.

seagull  However, given the stain and some of the features I now see that this is most likely Crypto. THey like similar. my bad
... trazabone made a comment on nbme24/block1/q#5 (The 35-year-old woman indicated by the arrow has a...)
 +0  upvote downvote
submitted by trazabone(2)

My understanding is that if parents are unrelated by blood to those affected, we assume that they are not carriers (in the recessive case). Therefore, if we have a male father affected with x-linked recessive married to a non-carrier, there's no way any of his offspring would be affected.

"If one parent is not a carrier, then a child can only inherit a disease allele from the other parent. In these problems, we can assume that any individual marrying into the family is not a carrier." https://www.cs.cmu.edu/~genetics/units/instructions/instructions-CP.pdf

... stars and more made a comment on nbme24/block1/q#5 (The 35-year-old woman indicated by the arrow has a...)
 +2  upvote downvote
submitted by stars and more(2)

X linked recessive there can never be any Male to Male transfer since the male offspring gets Y from father. the pedigree shows Male to Male transmission so this cannot be X linked recessive

... brethren_md made a comment on nbme24/block1/q#6 (A 57-year-old woman requires intubation in the...)
 +1  upvote downvote
submitted by brethren_md(18)

Transfusion-related acute lung injury (TRALI) is a rare but serious syndrome characterized by sudden acute respiratory distress following transfusion. It is defined as new, acute lung injury (ALI) during or within six hours after blood product administration in the absence of temporally-associated risk factors for ALI.

... mousie made a comment on nbme24/block1/q#6 (A 57-year-old woman requires intubation in the...)
 +0  upvote downvote
submitted by mousie(39)

Is 45 minutes too long to be anaphylactic and would the absence of rash (urticaria, pruritus) RO anaphylactic?

hayayah  Yes! Allergic/anaphylactic blood transfusion reaction is within minutes to 2-3 hours. (pg 114 of the 2019 FA has a list of them ordered by time)
hayayah  (also allergy / anaphylactic presents with more skin findings (urticaria, pruritus)
seagull  The time through me off too. I though ABO mismatch since it occured around an hour. I thought TRALI would take a little longer.
... gonyyong made a comment on nbme24/block1/q#7 (A 65-year-old woman comes to the physician because...)
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This was in NBME 20 as well. Its painless hematuria + papillary growth is showing transitional cell carcinoma This is associated with "Pee SAC": phenacetin, smoking, aniline dyes, and cyclophosphamide.

... lsmarshall made a comment on nbme24/block1/q#8 (A 24-year-old woman at 28 weeks' gestation is...)
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"The exact mechanism for tremor induction by β(2)-adrenergic agonists is still unknown, but there is some evidence that β(2)-adrenergic agonists act directly on muscle... More recently, tremor has been correlated closely with hypokalaemia." - NIH publication

First Aid mentions hyperthyroidism causing tremor from β-adrenergic stimulation. It also mentions β2-agonists causing tremor as a side effect. First Aid also mentions β2-agonists driving potassium into cells, which may contribute to tremor. That said, more classic symptoms of hypokalemia are wide QRS and peaked T waves on ECG, arrhythmias, and muscle weakness.

Looking around on the internet looks like if therapy is continued the tremor from a β2-agonists resolves overtime.

xxabi  Sketchy mentions tremor and arrhythmia as side effects!
... jus2234 made a comment on nbme24/block1/q#9 (The graph shows expiratory pressure-volume curves...)
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submitted by jus2234(2)

The graph shows a decrease in compliance of the lungs. Of the options, diffuse pulmonary fibrosis is the only choice that is an example of a restrictive lung disease which would decrease compliance

... keycompany made a comment on nbme24/block1/q#10 (A 75-year-old man is brought unconscious to the...)
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submitted by keycompany(47)

Image shows Crescent Sign, a common finding in Abdominal Aortic Aneurysms due to mural thrombus occlusion.

... njspix made a comment on nbme24/block1/q#11 (A 55-year-old man with type 1 diabetes mellitus...)
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Per UpToDate, the key here is the allodynia. This patient has intact sensation, it's just "turned up" way too much. The simplest way to explain this is that the sensor itself (the nociceptor) is over-activated.

Note that nociceptive pain (as this is termed) is more often due to inflammation/pressure/tissue damage, whereas neuropathic pain (more central) has a wide variety of causes (diabetes is a prominent one).

... seagull made a comment on nbme24/block1/q#11 (A 55-year-old man with type 1 diabetes mellitus...)
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Another approach. Diabetes causes non-enzymatic glycosylation which may negatively impact the function of neurons mainly due to altered blood supply among other things. These glycosylate deposits typically occur peripherally at the legs. The only peripheral answer choice was a nociceptor in the legs. all the other answer choices are at least more centrally located with larger blood supplies.

Again, not perfect but a way to reason out this answer but it does work.

... m-ice made a comment on nbme24/block1/q#12 (A 26-year-old man comes to the physician for a...)
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HMG CoA reductase inhibitors block the ability of the body to produce its own cholesterol. The liver, unable to make its own cholesterol and still needing to do its job of making lipoproteins, needs to get it from somewhere. So, the liver increases expression of LDL receptors to take more LDL out of the blood for repackaging.

... mousie made a comment on nbme24/block1/q#13 (A 4-year-old boy is brought to the emergency...)
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is this subacute endocarditis associated Membrano-proliferative GN?

jus2234  The question describes how he had a strep infection 15 days ago, and now this is poststreptococcal glomeruloneprhitis, which can also be described as proliferative glomerulonephritis
seagull  The question would be too fair if it just said PSGN. Instead we need to smell our own farts first.
yotsubato  And they used terminology NOT found in FA
... m-ice made a comment on nbme24/block1/q#14 (A thin 66-year-old man is brought to the emergency...)
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submitted by m-ice(39)

In SIADH, the excessive ADH causes the collecting duct of the kidney to reabsorb huge amounts of water that it should normally excrete. That means that the plasma will now have much more water relative to solute (low osmolality) and the urine will have much more salt relative to water (higher osmolality).

... karljeon made a comment on nbme24/block1/q#15 (Results of a 5-year screening program for HIV...)
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I don't know if there is an equation for this, but I basically pumped out every division across the table to get ~5% on average.

Here they are: 400 / 6,000 = 0.067 250 / 5,600 = 0.045 300 / 5,350 = 0.056 300 / 5,050 = 0.059 250 / 4,800 = 0.052

The average of these %s for all the years = 5.58%. So that's close enough to 5%.

seagull  good work. I found this question annoying and gave up doing those considering the amount of time we are given.
vshummy  Well just don’t include the intake year... because that messed me up..
_yeetmasterflex  How would we have known not to include the intake year? From average **annual** incidence?
lamhtu  Do not include intake year because the question stem is asking average annual incidence. The 4000 positives at intake could have acquired HIV whenever, not just in the last year.
... lsmarshall made a comment on nbme24/block1/q#16 (A 32-year-old man is brought to the emergency...)
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submitted by lsmarshall(88)

Flexor digitorum profundus is responsible for flexion of DIP. Medial aspect of the muscle (which flexes the 4th and 5th digit) is supplied by the ulnar nerve (C8, T1). The lateral aspect (which flexes the 2nd and 3rd digit) is innervated by the median nerve specifically the anterior interosseous branch (C8, T1). So the question is describing a laceration damaging the nerve supply to the DIP flexor of the 2nd digit (index finger). This is saying the medial nerve is being damaged (C8 and T1; lower trunk roots).

Lumbricals (1st/2nd, median; 3rd/4th, ulnar) are a group of muscles that flex at the MCP joint, and extend PIP and DIP joints.

Could remember as 'flexor digitorum profundus is profoundly long' since tendons insert on DIPs. Compared to flexor digitorum superficialis whose tendon wraps around profundus' superficially but inserts on PIPs.

... ihavenolife made a comment on nbme24/block1/q#17 (A 3-year-old boy is brought to the emergency...)
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submitted by ihavenolife(2)

Annular pancreas is an abnormal rotation of the ventral pancreatic bud. It encircles the 2nd part of the duodenum like a ring and narrows the lumen of the duodenum. If the pancreatic ring is tight enough to narrow the lumen enough, it leads to vomiting. The bilious vomiting implies the obstruction is distal to the Ampulla of Vater.

Other answers

Pyloric stenosis -> NONbilious projectile vomiting, olive-shaped mass in epigastric region

Esophageal atresia -> would be non bilious as well. usually neonates present with drooling, choke and vomit with FIRST feeding, this boy is 3 yrs old so it is unlikely.

Biliary atresia -> Fibro-obliterative destruction of extrahepatic bile duct, leads to cholestasis. Usually newborn with jaundice, dark urine and acholic stools because bile backed up.

... haliburton made a comment on nbme24/block1/q#18 (A 34-year-old woman with a long history of...)
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Infliximab is a TNF-alpha inhibitor. from pubmed TNF-α has been demonstrated to have a central role in the host response against tuberculosis, including granuloma formation and the containment of disease (14,15). Notably, antibodies against TNF-α induced reactivation of tuberculosis

bigjimbo  TB can spread to psoas L1-2 often, which then goes to the actual L1-L2 vertebrae itself (Potts or osteomyelitis)
... sympathetikey made a comment on nbme24/block1/q#19 (A 35-year-old man comes to the physician because of...)
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submitted by sympathetikey(102)

Buzzword: excessive tearing

Cluster headaches, in questions, always come with autonomic symptoms.

... m-ice made a comment on nbme24/block1/q#19 (A 35-year-old man comes to the physician because of...)
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submitted by m-ice(39)

The patient in this question has cluster headaches. These headaches can be differentiated from migraines and tension headaches, as they tend to come in episodes across several years, with absent periods in between. Cluster headaches are often described as excruciatingly painful (sometimes called "suicide headaches").

... lsmarshall made a comment on nbme24/block1/q#20 (Immediately after a spontaneous vaginal delivery, a...)
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Patient has Spina bifida occulta which is a neural tube defect (failure of fusion of the neuropores). Sclerotomes are the part of each somite in a vertebrate embryo giving rise to bone or other skeletal tissue. Since a part of this patient's spina bifida included "abscense of spinous process" then a sclerotome was involved. Knowing that neural tube defects are an issue with fusion should be enough to get to the right answer.

If the notochord failed to develop then the entire CNS would not develop as the notochord induces formation of neural plate.

If the neural tube failed to develop then the whole CNS would not have developed.

Yolk sac is irrelevant to this patient.

When neural crest cell it has different outcomes in different tissues. Failure of neural crest to migrate in heart can cause Transposition of great vessels, Tetralogy of Fallot, or Persistent truncus arteriosus. Failure of neural crests to migrate in GI can cause Hirschsprung disease (congenital megacolon). Treacher Collins Syndrome can occur when neural crest cells fail to migrate into 1st pharyngeal arch. Neural tube defects has nothing to do with failure of neural crest migration though.

sympathetikey  Exactly. I knew it had to due with fusion of the neuropores but had never heard of sclerotomes. Thanks for the explanation.
... ameanolacid made a comment on nbme24/block1/q#21 (A 35-year-old woman comes to the physician because...)
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Great image showing the anatomical relationships:

https://embryology.med.unsw.edu.au/embryology/images/0/03/Thyroid-development-cartoon.jpg

... famylife made a comment on nbme24/block1/q#22 (A 50-year-old man undergoes surgical transection of...)
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"Innervates the muscles of the medial compartment of the thigh (obturator externus, adductor longus, adductor brevis, adductor magnus and gracilis)."

https://teachmeanatomy.info/lower-limb/nerves/obturator-nerve/

famylife  Pics: https://www.google.com/search?rlz=1C1CHZL_enUS753US753&biw=1368&bih=809&tbm=isch&sa=1&ei=W6P6XJa3NMSQggfa35YY&q=obturator+nerve+adductors&oq=obturator+nerve+adductors&gs_l=img.3...9024.9024..9214...0.0..0.82.82.1......0....1..gws-wiz-img.rjc4GuKQAYo#imgrc=ZqWtUuDxpzeNMM:
... karljeon made a comment on nbme24/block1/q#23 (A 50-year-old man comes to the physician because of...)
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A man with a Hx of EtOH dependence and chronic abd pain as well as X-ray findings of "calcifications in the mid-upper abdomen" is most likely referring to a chronic pancreatitis.

This leads to a lack of lipase secretion hence, pale, foul-smelling stools with oil droplets per pt Hx. This pt's pancreas also doesn't secrete other enzymes, such as amylases, proteases, nor trypsinogen (to activate other enzymes), so the answer is "generalized malabsorption".

karljeon  p. 367 (FA 2018)
... sympathetikey made a comment on nbme24/block1/q#24 (A 6-year-old girl is brought to the office by her...)
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submitted by sympathetikey(102)

Pediculus Humanus

Blood-sucking lice that cause intense pruritus with associated excoriations, commonly on scalp and neck (head lice), waistband and axilla (body lice), or pubic and perianal regions (pubic lice).

Best give away in this question, for me, is the "white, globular protuberances". Looks just like the pic in First Aid 2019 (see below).

https://i.imgur.com/mh5JA2D.png

... seagull made a comment on nbme24/block1/q#25 (A 7-year-old boy has metabolic acidosis and...)
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submitted by seagull(158)

I thought this was a type 1 RTA but I was wrong. Any suggestions?

seagull  It looks like it was a type II RTA. The difference is incredibly subtle from the info given in this question.
gonyyong  He has Fanconi syndrome which is generalized reabsorption defect in PCT which leads to metabolic acidosis and hypophosphatemia → can lead to rickets Also, does lead to type II RTA
... radshopeful made a comment on nbme24/block1/q#26 (An 80-year-old woman with poorly controlled type 2...)
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chronic kidney disease --> decreased EPO --> decreased hematocrit chronic kidney disease --> decreased PO4- excretion --> increased PTH chronic kidney disease --> decreased 1,25 dihydrovitD (calcitriol) --> increased PTH

... lsmarshall made a comment on nbme24/block1/q#27 (A 10-year-old girl with a lifelong history of...)
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"Parasternal heave (lift) occurs during right ventricular hypertrophy (i.e. enlargement) or very rarely severe left atrial enlargement." RV hypertrophy can be seen so easily because the RV is at the anterior surface of the chest.

In this patient blood from LA to LV decreases in saturation, so it is going somehwere. From the O2 sat. we can deduce there is probably a VSD (increased RV pressure would cause RVH and parasternal heave). Furthermor, the vignette is likely describing tetralogy of fallot (caused by anterosuperior displacement of the infundibular septum). In Tet spells, RV outflow is too obstructed and patient gets cyanosis and R>L shunting Squats increase SVR, decreasing R>L shunting, putting more blood through pulmonary circuit and relieving cyanosis.

seagull  i'm pretty sure your a prof and not a student.
... tea-cats-biscuits made a comment on nbme24/block1/q#28 (A 32-year-old woman comes to the physician because...)
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Mast cells degranulate, producing histamine which attracts eosinophils. The early stage of an allergic reaction is mast cell mediated, but the late stage (including mucus production) is mediated by eosinophils.

atstillisafraud  Thanks for a good answer. This question made me feel like I was taking T21 pills
... m-ice made a comment on nbme24/block1/q#29 (An 80-year-old woman comes to the physician because...)
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The jaw pain and headaches in an older woman are worrisome for Temporal Arteritis. This is a vasculitis, which could be best identified by determining the erythrocyte sedimentation rate.

... tea-cats-biscuits made a comment on nbme24/block1/q#30 (A 55-year-old man is brought to the emergency...)
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submitted by tea-cats-biscuits(25)

Patient has cardiogenic shock, specifically the LV since it’s an anterior wall MI isn’t pumping. Honestly you don’t need to know what happens to PVR to answer correct since the only choice that has increased SVR and decreased PCWP is the one w/decreased PVR. I’m not absolutely sure if you could figure it out given the values in cardiogenic shock. The equation linking the values is:

PVR = (pulmonary arterial pressure - wedge) ÷ CO

... 2zanzibar made a comment on nbme24/block1/q#30 (A 55-year-old man is brought to the emergency...)
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submitted by 2zanzibar(2)

Patient is in cardiogenic shock. Characteristic features of cardiogenic shock: increased cardiac pressures and decreased cardiac output due to impeded forward flow, as well as increased systemic vascular resistance

... pseudorosette made a comment on nbme24/block1/q#30 (A 55-year-old man is brought to the emergency...)
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Why is it that the pulmonary capillary wedge preesssuree is increased? on pg. 307 of FA 2019 it says it can be increased or decreased :/

... famylife made a comment on nbme24/block1/q#30 (A 55-year-old man is brought to the emergency...)
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