NBME 1

Saturday, May 28, 2011

4:12 PM

===========Nbme 1===========================================

1. bv
2. cv
3. Bv
A PE from a DVT.
4. ev
5. Bv
B is right because the cause of cellular swelling is depletion of ATP [which leads to decreased activity of sodium potassium
ATPase pump leading to accumulation of sodium in the cell...water is drawn into the cell leading to cellular swelling].

Pasted from <http://www.aippg.net/forum/f18/45-year-old-woman-74414/>

Though I have seen answer c in other places, but for c to happen ATP depletion must occur first.

6. av
7. Iv

S4 is the answer because it is a late diastolic murmur with the high BP, LVH will result.

Blood pressure
Left arm 226/120 mm Hg-----> PP=226-120=106
Right arm 218/118 mm Hg---->PP=100mmHg

This wide pulse pressure could result in LVH due aortic insuffis. eventhough we have a late diastolic sound in the context of
10 years of HBP, the stiffness of LVH could be the cause of this late sound.

Pasted from <http://www.aippg.net/forum/f18/50-year-old-man-76477/>

8. Ev
Inhibitor of phosphoribosylpyrophosphate synthetate is ADP
9. av
10. ev
11. Dv
If DNA cools too quickly it binds incorrectly.
12. ev
13. bv
14. bv
15. bv
16. dv
17. av
18. bv
19. cv
20. bv
21. cv
22. cv
23. ev
24. Cv

immunoglobulin concentrations are frequently normal, but antibody responses, particularly of IgG and IgA isotypes, are usually
impaired. T cell levels are reduced, whereas B cell levels are normal

Pasted from <http://accessmedicine.com/content.aspx?aID=2858675&searchStr=digeorge+syndrome#2858675 >

What are top t cell deficiencies 3 ADA de, degeorge, X linked scid
Which can have normal immuno globins Only degeorge, but this is variable

NBME answers-explanations Page 1

 Which can have normal immuno globins Only degeorge, but this is variable
Disorder of both t and b cells EASP
What could be normal in WASP IgG> E> A
But never IgM

25. av
26. ev
27. fv
28. av
29. dv
30. dv
31. dv
32. dv
33. av
34. hv
35. Av
36. ev
here it says large amt.so it must b varices.....in mallory weiss der wud b less amt of bleeding...n pt never get hypovolemic shock n die..
so ans z varices...eeeeee

Pasted from <http://www.usmleforum.com/files/forum/2006/1/137593.php>

Pain = mallory weiss.

this is picture of varices

NBME answers-explanations Page 2

 varice death is due to bleeding
Patients who have bled once from esophageal varices have a 70% chance of rebleeding, and approximately one third of further
bleeding episodes are fatal. The risk of death is maximal during the first few days after the bleeding episode and decreases slowly
over the first 6 weeks. Mortality rates in the setting of surgical intervention for acute variceal bleeding are high.
Associated abnormalities in the renal, pulmonary, cardiovascular, and immune systems in patients with esophageal varices
contribute to 20-65% of mortality.

Pasted from <http://emedicine.medscape.com/article/175248-overview#showall>

mortality from boerhever is more from infectio

n
Overall mortality rate is approximately 30%.Mortality is usually due to subsequent infection, including mediastinitis, pneumo nitis,
pericarditis, or empyema

Pasted from <http://emedicine.medscape.com/article/171683-overview#showall>

37. av
38. dv Was wrong put a x.
criteria for depression SIGE CAPS
sleep
interest
guilt
energy
concentration
appetite
psychomotor
Suicide
depression is not always necessary
39. bv
40. bv
41. ev
42. dv
43. bv
Ataxic limb movement. Got this from a forum
first step: which artery is involved? as seen in angiogram this artery arise form proximal portion of basilar artery, so this is anterior inferior
cerebellar artery (AICA).
secont step: which structures supply AICA. AICA supplies the caudal lateral pontine tegmentum, and inferior surface of the ce rebellum.
third step: choose from given answer options which is characteristic for cerebellar dysfunction. a, d, e are characteristic f or hemisphere

NBME answers-explanations Page 3

 third step: choose from given answer options which is characteristic for cerebellar dysfunction. a, d, e are characteristic f or hemisphere
c. is characteristic for basal ganglia
only b. ataxic limb movements left, which is the correct answer

Pasted from <http://www.usmleforum.com/files/forum/2010/1/483762.php>

qwerqwer

a PCA
b Sup cerebellar artery
c bascilar artery
d -extra credit roof IV ventricle
e - extra credit tonsil
f PICA
g vert artery
h - extra credit caudal loop pica
I - extra credit projection vermis
j- extra credit hemisphric branch pica
k - extra credit tontorium cerebelli
L vermian branch of sup cerebellar arteria
m - extra credit calcarine artery
n precentral branch of sup crebellar artery
o- extra credit tonsillar loop of pica

44. dv
45. av
46. dv
D- Vasectomy is not immediately effective because viable sperm remain for weeks in the urethra above the cut
vasa. International guidelines recommend that couples use another method of contraception, such as condoms, for
12 weeks or 20 ejaculations, after which these residual sperm should be gone.

Pasted from <http://www.prep4usmle.com/forum/thread/44871/>

NBME answers-explanations Page 4

47. cv
48. cv
49. dv
50. av

2 did not know PRPP syn, digeorge,

1 most common problably rule varices
3 diagnosis rule out rule (s4 sound, PE, anorexia vs depression)
1 misuse of infor/ did not read whole problem (, , DNA,polymerase chain )
1 stem generate (vertebral)
1 did not ask, what is the clue
Rule for short breath Rule out PE, then infarction
diagnosis rule rule out half at a time , and then add a symptoms to keep being more specific
Rule Scan answer for unfamilar answer TO YOU. -analyze all answers
Enzyme regulation Is as far upstream as possible without effects branhcing pathways
for diagnosis try to rule out everything properly beyond a doubt
when splitting hairs go through each symptoms and ask ,what more commonly has "….."
if you can't see a picture try to generate hypothesis from the stem
if you have no clue start asking ,what is the clue
40/50=0.8

section 2 ============
1. ev
2. av
abnormal utilization of iron
3. av
4. cv
5. cv
6. ev
unable to determine because the question did not give us that specific year to calulate for that year

Pasted from <http://www.valuemd.com/behavioral-science-forum/35467-incidence.html>

7. fv
8. dv
9. dv
10. av
11. av
12. dv
13. av
14. cv
15. dv
IL1 on b cells proliferatio
neutrophils chemotacts
NK cells activation
vascular endothelial cell ICAM expression
TH cell activation
where are leukotrienes made neutorphils, leukocytes many cells
theme of IL1 proliferation of cells, not
production of antibodies or PG
Kaplan has IL-1 (from macrophages) function as

1)stimulator of IL-2 secretion--IL-2 stim B cells and stimulates T cell growth factors

NBME answers-explanations Page 5

 1)stimulator of IL-2 secretion--IL-2 stim B cells and stimulates T cell growth factors
2) pyrogen

Pasted from <http://www.prep4usmle.com/forum/thread/36632/>

16. hv
17. av
18. cv
19. gv
20. bv
21. bv
22. cv
23. dv
24. cv
25. cv
26. dv
27. dv
28. Cv
when the postive predicitive value increases the prevalence increase as the more the ppl who has the disease" the
prevalnce" the more when u will do the test it will be postive
in the question the disease is neural tube defects , the best measure to be sure that it is positve is the prevalence
of the population , the more ppl having it the more the test will be +ve
twins has no relation to the disease , nor the specificty or sensitivity , and serum alpha feto protein is a good
measure but it s not the thing that u can say to the patient i m sure that u have the disease like increaing the
prevalence in a society
so know this : increase +ve predicitve value increase prevalence

Pasted from <http://www.prep4usmle.com/forum/thread/62477/>

Predictive values are related to the prevalence of a disease. The higher the prevalence, the higher is the positive predictiv e
value and the lower the negative predictive value.

Pasted from <http://www.usmle-forums.com/usmle-step-1-forum/6982-nbme-form-1-questions.html>

29. cv
30. bv
31. Av
Put f because I was thinking of the empty can test.
32. fv
33. bv
34. cv
35. dv
36. bv was wrong put a x.
• The most common organism of both fungal NVE and fungal PVE is Candida albicans.
• Fungal IVDA IE is usually caused by Candida parapsilosis or Candida tropicalis.
• Aspergillus species are observed in fungal PVE and NIE.

Pasted from <http://emedicine.medscape.com/article/216650-overview#showall>

most common cause of fungal endocarditis? candida

37. ev
38. cv
39. cv Was wrong put a x.
Laminin is a part of what class integrin
key was cell membranes
40. av
41. dv

absent bowel sounds in small bowel obstruction, and peritoniitis

but which has guarding peritonitits

NBME answers-explanations Page 6

 but which has guarding peritonitits
possible reason low potassium
it is one sign of peritonitis. B/c of hypokalemia induced lack of peristalisis. It is also called Paralytic ileus.

Pasted from <http://www.aippg.net/forum/f18/45y-male-has-nausea-90785/>

Often after surgery ileus can occur,
sympathetic over action
the effects of manipulation of the bowel
potassium depletion (where there has been excessive pre -operative vomiting)
peritoneal irritation from blood or associated peritonitis, and
the atony of the stomach and the large bowel.

The above occur after every abdominal operation for a period of about 24 to 48 hours. The distention which occurs on the
first and second postoperative day is probably produced by swallowed air passing through the small intestine, where
peristalsis usually remains fairly normal post -operatively, to the colon, which is atonic and produces a functional hold up.

Paralytic ileus, which persists for more than 48 hours post -operatively, probably has some other etiological factor present.
In the established case of paralytic ileus, continuous nasogastric suction is employed to remove swallowed air and prevent
gaseous distention. The aspiration of the fluid also helps to relieve the associated gastric dilatation. Intravenous fluid an d
electrolytes are instituted with careful biochemical control. Pethidine and chlorpromazine are used to allay discomfort and
nausea. Eventually patience is rewarded and recovery from the ileus will occur unless it is secondary to some underlying
cause, such as infection.

In the absence of any evidence of mechanical obstruction or infection, prolonged stubborn ileus is occasionally treated
pharmacologically by means of guanethidine in order to block sympathetic inhibition of the intestine, this is followed by
parasympathetic stimulation, either with a cholinergic agent (bethanecol chloride) or an anticholinesterase drug (e.g.
Prostigmin). One should not initially stimulate the bowel with parasympathomimetic drugs.

Reoperation should not be planned because it may be possible to control infection by antibiotics in the hope that the ileus
will resolve.

Pasted from <http://www.valuemd.com/surgery-forum/35528-paralytic-ileus-secondary-generalized-peritonitis.html>

42. fv
--decreased breath sound ...may signify among many choices...e,f.g
--dullness to percussion ---signifies lobar consolidation(e) and pleural effusion(f)..pneumothorax is out (hyperresonance is
the one u get in percussion in case of pneumothorax ))....
--decreased vocal and tactile fremitus---signifies pleural effusion

Explanation --Tactile fremitus is pathologically increased over areas of consolidation and decreased or absent over areas of
pleural effusion or pneumothorax (where there is liquid or air instead of usual lung)....

Pasted from <http://www.aippg.net/forum/f18/49-yrs-old-man-84174/>

43. av
44. av
45. cv
46. ev
47. dv
48. cv
49. dv
50. cv

42/50 = 0.84
2 did not know candida, peritonitis
2 misuse of info afp ; strange answer choice, relook question data PPV, integrin
2 read all answer hemolysis, motor vehicicle fatal
1 example elimination -t lymphocytes
1 Don't answer with DIT knowledge, answer with basic knowledge first
read all answer !!!!
for question asking a general mechanism you know the ndemanding a specific answer; think of what the

NBME answers-explanations Page 7

 for question asking a general mechanism you know the ndemanding a specific answer; think of what the
other askwer have that are specific, the most general one is right (IL1 t cell impairement
a starnge wording might the question is asking something different than you though
mean
confused by wording simply it remove fluff
for diagnosis and figure by elimination, not positivitvity
worded mech best to

===section 3=====
9: 08
1. bv
2. cv
3. d…a?v
4. Cv
CC u missed the word"inhibitory"
loss of enteric inhibitory motor innervation.

pt had postcholecystectomy stenosis of S.O. Oddi (increased in sphinctor basal pressure) that does not relaxes by the inhibit ory effect of CCK.
normaly CCk cz inhibition via non-adrenergic non-cholenergic(NANC) enteric nerve supply.

it's the similar pathology as we see in ACHALASIA where loss of inhibitory effect of VIP as a neurotransmiter and pyeloric sp hinctor does not relax.

Pasted from <http://www.usmleforum.com/files/forum/2009/1/465808.php>

common complication from any surgery is severing of nerve or a

tube (ureter) in
hysterectomy
This is a bad question, but the best answer is vagus related

It remains unknown

http://books.google.com/books?id=taE276KCyecC&pg=PA308&lpg=PA308
&dq=vagus+sphincter+of+oddi&source=bl&ots=2EaF8bKk4E&sig=
5jd4OG7-4ghKxVdVlQO53V_WdcU&hl=en&ei=HYP7TdToMe2o0AGC4-
mUAw&sa=X&oi=book_result&ct=result&resnum=4&ved=0CDEQ6AEwAw#v=onepage&q=vagus%20sphincter%
20of%20oddi&f=false

5. av
6. bv
7. ev
barbiturates are notorious for causing diverse/severe withdrawl effects...therefore i will select
secobarbital....sudden withdrawl can cause seizures.

Pasted from <http://www.prep4usmle.com/forum/thread/6082/>

worse withdrawal from barbiturates

NBME answers-explanations Page 8

 8. dv
9. bv
10. av was wrong put d x.
Definition of persistent vegetative state wakeful unconscious state that lasts longer than a few weeks

Pasted from <http://en.wikipedia.org/wiki/Persistent_vegetative_state>

brain death definition? irreversible end of all brain activity (including involuntary activity necessary to sustain life

Pasted from <http://en.wikipedia.org/wiki/Brain_death>

11. cv
12. ev
13. av
14. ev
15. ev
16. cv
17. ev
18. ev
19. dv
20. bv was wrong put a x.
what is Denoting an enhanced reaction of the body's immune system to an antigen that is related to an antigen
anamnestic previously encountered

Pasted from <http://www.google.com/search?sourceid=chrome&ie=UTF-8

&q=anamnestic+producton#sclient=psy&hl=en&source=hp&q=anamnestic+&aq=f&aqi=g5&aql=f&oq=&pbx=1&bav=on.2,or.r_gc.r_pw.
&fp=a17560d1ef61d5f5&biw=964&bih=1045>

Stem states the tested positive in third trimester for Rh antibodies, implying she tested negative in 2nd and 1st. This rules out a and c
leaving only b.
we took care of it for the first pregnany by giving "PASSIVE Ati -RhoG Ig"(premade Ab) that grabed all the fetal RBCs which made it to mother
circulation(at time of delivery) BEFORE they form the Rh-specific Memory B cells.
anti-RhoG IgG would last few weeks cz IgG half life is arroun 21 days or so,so choice C is not correct.

during second pregnancy Mother got perinetal exposure in her 3rd Trimester.and Intrauterine Transplacental hemorrhage is one of the causes of
exposure.Exposure can also be caused by pregnancy loss or Invasive procedures e.g. Amniocentesis or Fetal blood sampling.

Pasted from <http://www.usmleforum.com/files/forum/2010/1/484198.php>

21. bv
22. bv
This is a bad question because aspirin use in elderly is NOT advised.
An expert panel of American Geriatrics Society is all but "crossing off" non -steroidal anti-inflammatory drugs (NSAIDs) from its list of recommended drugs
for older adults with chronic, persistent pain. The long -term use of NSAIDs such as ibuprofen, aspirin, and naproxen has been linked to a number of
problems in the elderly, including gastrointestinal bleeding, an increased risk of heart attacks and strokes, impaired kidney function, and elevated blood
pressure. The drugs can also interact badly with other medicines, including those for heart failure. Experts say the elderly are better of using
acetaminophen (Tylenol) or even narcotic painkillers, despite the fact that these prescription medications can be addictive.

Pasted from <http://www.healthcentral.com/rheumatoid-arthritis/news-288826-98.html>

23. gv
24. dv
25. ev
26. dv
27. ev
28. av
29. ev
30. bv
31. bv
32. bv

NBME answers-explanations Page 9

32. bv
33. av
34. av
35. dv
36. dv
37. bv
38. bv
39. dv
40. av
41. av
42. bv I put a x.
what is a concatemer long continuous DNA molecule that contains multiple copies of the same DNA sequences linked in series

Pasted from <http://en.wikipedia.org/wiki/Concatemer>

what causes them result of rolling circle replication, and may be seen in the late stage of bacterial infection by phages

Pasted from <http://en.wikipedia.org/wiki/Concatemer>

transpoons can transposons can jump from

Pasted from <http://en.wikipedia.org/wiki/Transposon>

The two things to consider are that 1) the plasmid started out at 15 kb, and ended up as 20 kb, the plasmid gained DNA
some how and 2) the same increase in plasmid size results in two very specific mutations.
The only option that satifies these two conditions is the insertion of a transposon (5 kb gain of DNA) at two different sites
that inactivates antibiotic resistance at the two sites of insertion.

Pasted from <http://www.aippg.net/forum/f18/bacterium-harboring-15-ooo-60207/>

43. cv
44. cv
45. dv
In animal research, scientists found that during a stroke or other brain insult, some brain neurons die because of profound
lack of oxygen, while other neurons die from resulting chemical reactions. In particular, oxygen deprivation triggers a
buildup of an excitatory chemical neurotransmitter, called glutamate, which acts at NMDA receptors.

the action of NMDA receptors appears particularly important because they have the special ability to let large amounts of
calcium, an important mediator of glutamate destruction, into neurons. Calcium entry starts a chain of biochemical
reactions within the neuron that eventually leads to its death. Because of this "gatekeeper" role, NMDA receptors are
important targets for developing therapies to reduce glutamate action

D is the best answer.

Pasted from <http://www.aippg.net/forum/f18/pharmaceutical-company-has-developed-82782/>

activation of NMDA causes opening of ion channel

type type that is nonselective to cations
most effect are created by influx of caclium
too much results in cell death
when does the cell let in too much calcium when too much glutamate is activating receptor
when is too much glutamate release during oxygen ischemia, for example a
stroke
46. av
47. dv I was wrong and put e x.
Tough, good debate found here
http://www.prep4usmle.com/forum/thread/49018/
Neurologic presentation is with seizures and progressive psychomotor retardation beginning in early childhood

NBME answers-explanations Page 10

 Neurologic presentation is with seizures and progressive psychomotor retardation beginning in early childhood

Pasted from <http://accessmedicine.com/content.aspx?aID=12938&searchStr=tuberous+sclerosis >

48. bv
49. cv
50. av

3 did not know brain death, transpoon, cell death NMDA

1 did not know surgery nerve rule
1 misuse of info RH d -broke diagnosis wrap up rule
1 treatment postiive is first>adverse
1 broke early rule

for surgery complication assume neural problems over local problems of mechanics (gallbladder)
for ruling out diagnosis must reread question to confirm to wrap up
treatmetn 1 treatment postiive is first>adverse (aspirin vs cochicine for OA)
43/50 = 0.86

=====section 4==============
1. av
2. Bv
This Gap
junction

NBME answers-explanations Page 11

NBME answers-explanations Page 12
NBME answers-explanations Page 13
 Survey freeze-fracture view of a lipid-laden macrophage immunogold labeled (18 nm gold) for adipophilin.
Prominent labeling is seen on the P-faces of plasma membrane (PL) and ER membranes (ER), and on lipid droplets
(LD). The E-face of the ER membranes, mitochondrial membranes (M) and vesicle membranes are devoid of label. Bar,
0.2 μm.

Pasted from <http://jcs.biologists.org/content/119/20/4215.full>

3. Av

4. fv
5. Cv
6. Hv
But that is now where close to an adrenal tumor
Compare

NBME answers-explanations Page 14

 Compare

T12 cut from netters

7. cv
8. av
9. ev
10. dv
11. ev
12. Bv
This Myelofibrosis

NBME answers-explanations Page 15

 This Myelofibrosis

Aplastica nemia

13. Bv
14. F x
Mech for bradykinin pain? Activates bradykinin receptor B1, a receptor expressed only as a result of tissue injury
15. bv
16. ev
17. cv
18. dv
19. cv
20. av
21. I (i)v
22. Bv
Vancomycin oral bioavailablity? 0, stays in intestine, good for difficile
Gentamicin Low, given
IM or IV
23. ev
24. dv
25. Bv I was wrong and put b a x.
Best for fixing complement is IgM
Best IGG? IgG3
Opsonization requires what antibody IgG
Antigen stimulation first stimulates what Somatic hypermutation

NBME answers-explanations Page 16

 Antigen stimulation first stimulates what Somatic hypermutation
Somatic hypermutation / somatic mutation is Random single nucleotides are rearranged on heavy and light chain in the variable
when region
What comes after Affinity maturation
What is that? The proliferation of b cell in which the b cell with the higher affinity antibody
removeduces
Final phase is Isotype switch

26. cv
27. cv
28. av
29. dv
30. gv
31. bv
32. ev
33. ev
34. ev
35. dv
36. Ev
Yes it's E) Wernicke's area: language comprehension center. areas 22(temporal L), 39 and 40 (parietal L)

Pasted from <http://www.prep4usmle.com/forum/thread/27117/>

37. av
38. Cv I was wrong and put a x.
This

Maxillary would be more in the center and rostral

NBME answers-explanations Page 17

Blue is anterior fossa, yellow is middle
Pterygopalatine fossa would be slightly medial and more midline to y

NBME answers-explanations Page 18

39. ev
40. dv
41. dv
42. av
43. Ev
44. Cv I was wrong and put c x.
45. Bv
46. av
47. hv
48. cv
49. cv
50. Ev

4 did not know (raft); bradykinin, complement, fossa

1 math error
1 stretched a definition systemic
---
Stop miskeying
-
44/50 = 0.88
Rule for math Was dr. ward method
If it seems to easy Reread the question

NBME answers-explanations Page 19