Keep in mind, that we do not know the predictive ability of the soon to be released new NBME Forms–Forms 20, 21, and 22. However, we can infer that because NBME Form 19 is being retired, the NBME has realized that this practice exam has caused problems for students preparing for the exam. Study nbme 19 flashcards from 's class online, or in Brainscape's iPhone or Android app. ✓ Learn faster with spaced repetition.
NBME 19 discussion Spoiler. Please dont put answers only, put explanations to why please.
Diagnosis of cancer, weight loss, cachexia and significant muscle wasting. The breakdown of muscle proteins in the patient was most likely preceded by conjugation of the porteins with which of the following substances?
A) BCl2 B) Catalase C) Copper D) Cytochrome C E) Lysozyme F) Phospholipase A2 G) Ubiquitin
***The reason its not ubiquitin its because ubiquitin has to do with going to proteins that are already damaged like broken? cytochrome c binds to proteins that aren't damaged but want to degrade??I got confused and put ubiquitin
10 yo girl painful 2mm subcutaneous nodule on chin. 10 wks ago required sutures after laceration. Photo of tissue biopsy given. Dx? a. Granuloma b. Granulation tissue c. Amyloid d. Lymphocytic infiltrate e. Neutrophilic infiltrate
**I keep confusing granuloma and granulation tissue. Can someone explain in simple terms the different regarding a question to differentiate them.
24) Case control study. 100men with bladder cancer compared to 100 controls. Case and control asked about EtOH consumption. Odds ratio of 3. 95% confidence interval was 1.8-6.6 for association of bladder cancer to EtOH consumption. Interpretation?
a. The likelihood is 95% that the true value for the odds ratio is between 1.8-6.6. b. There is a 95% chance that the true odds ratio is 3.00 c. At least 5% of consumers of alcohol will develop cancer of the bladder. d. Men who drink alcohol are 5 times more likely to develop bladder cancer than those who do not drink alcohol
**Im confused regarding this, can someone explain me this on how you would conclude and say what is this like these options in simple words VS. relative risk
32) 32 yo woman with fecal incontinence after child birth. Dx? a. Damage to anal sphincter b. Spastic contraction of puborectalis muscle c. spastic external anal spinchter d. achalasia of internal anal sphincter
**I assumed puborectalis muscle damaged by levator anti because was pregnant
3 tests evaluate children with diarrhea for rotavirus. Sensitivity and specificity are summarized. If only treat children actually have disease because of toxicity of treatment, which tests should be run?
Test 1 Sensitivity 70 and Specificity 100 Test 2 Sensitivity 90 and Specifiticity 95 Test 3 Sensitivity 95 and Specificity 70
A. Test 1 followed by test 3 if test 1 is positive B Test 3 followed by test 1 if test 3 is positive C. Test 2 only D. Test 2 followed by test 3 if test 2 is negative E. Test 2 followed by test 3 if test 2 is positive
**This one I have NO IDEA, i hate biostats. not my thing.
47) 62 yo woman with abdominal aortic aneurysm repaird. 48 hr later right distal leg dusky, cool and dark purple to black necrotic lesions on several toes. Biopsy of lesion shows occluded small arteries with needle shaped clefts. Dx?
A. Arterioal narrowing B. Septic emboli C. Cholesterol emboli D. Vasospasm E. Venous thrombosis
40 yo woman lump in neck became larger recently. 8x10mm mass lateral to midline over thyroid cartilage. Soft, mobile and moves upward when patient protrudes tongue. Whats structure?
A. Hygroma B. Thyroglossal cyst B. Dermoid cyst C. Lymph node
***So because of the protrudes her tongue it moves i thought thyroglossal cyst but should thyroglossal cyst be midline not lateral? I'm confused
44) 53 yo woman w/ GERD. Dietary change and stress reduction no effect symptoms. Physical exam shows mild epigastric tenderness. Tx?
A. Omeprazole B. Misoprostol
**I dont know why I saw healing esophageal mucosa thought of protection to barrier and put stupidly misoprostol....
8) 62 yo woman weakness of left leg. Smoked 1 ½ pack for 40 yrs. BMI 27. P85, BP140/100. Left lower extremity shows muscle strength of 1/5 and deep tendon reflexes of 3+. When eyes closed, she cannot tell left great toe is raised or depressed. Embolism of what arteries?
A. Right anterior cerebral B. Right radicular branches of the posterior spinal
**Yup, I put B. Im so stupid... I put it thinking about propiocpetion Idk lol.
26) Study function of voltage-gated sodium channel. A mutant form that inactivates more rapidly than normal is developed. Whats effected?
A. Decreases amplitude of action potential B. Decreases maximum frequency of action potential production C. Increases conduction velocity of axon D. Increases input resistance of axon E. Increases rate of depolarization of action potential
***Whats the answer and why
31) 5 yo boy pain in right eye at night. No Fx of neoplasia. Exam shows strabismus and tenderness in eye. Left eye normal. Retina show presence of mass. Physician explain unlikely to develop other neoplasms. Mutation occurs?
A. Retinal cells B. Somatic cells of parents C. Somatic cells of child D. Germ cells
**Why not somatic cells?? whats the answer and why, like how to differentiate
13) 52yo woman with non-small cell carcinoma treated w/ cisplatin. What other drug needed? A. Metoclopramide B. Prochlorperazine C. Scopolamine D. Dronabinol E. Ondansetron
**What is the answer and why??
46) 30yo man with urinary incontinence after tx of left pelvis fracture. Physical exam show distended bladder, absence of micturition reflex. After bladder fills to capacity, overflow of urine occurs through urethra by few drops. What other nerve injury?
A. Pelvic nerves B. Pudendal nerves C. External urinary sphincter
**Explain which one and why not the others
29) 35yo man want to donate kidney to his sister who is T1DM and chronic renal failure. Healthy, physical exam normal. How likely his HLA type is a match?
A. 1:1 B. 1:2 C. 1:4 D. 1:6
**Which one and why?
21) Mouse thymocyte obtained from normal active bone marry was altered to express bcl-2 and combined with normal marrow cells was injected into mice w/ destroyed active marrow. Control mouse with destroyed marrow was injected w/ normal marrow only. After recovery, whats different between mouse?
A. Decrease cell death in thymic cortex B. Increase number circulating plasma cells C. Decrease number of circulating lymphocytes D. Decrease overall risk of autoimmunity E. Increase formation of lymphoid nodules in thymic cortex F. Decrease naive B lymphocytes production by reconstituted marrow
**I put increase number of circulating plasma cells, why its wrong??
49) 1 day old newborn tested for anti-HIV antibodies. Western blot confirm presense of IgG antibodies which react with virus envelope and core glycoproteins. Dx?
A. Both newborn and mother infected B. The mother is infected, status newborn uncertain C. Newborn is infected; infection occurred at birth D. Newborn infected; infection occurred in utero E. Newborn infected; status of mother is uncertain
**What is the answer and why?
32) Oral fluid therapy used to tx vibrio cholerae. Which membrane transport stimulated? So apparently its Na and Glucose cotransport :/ I got it wrong. Im confused...... can someone explain.
50) 2 wk old full term female newborn develops pale stools and progressive jaundice. Nuclear scans show no excretion of bile. A1AT deficiency ruled out. Liver biopsy shows inflammation and proliferation of small bile ducts and increased portal fibrosis. If not treated, what develops?
A. Budd Chiari syndrome B. End stage cirrhosis C. Hepatocellular carcinoma D. Recurrent episodes of hepatitis
**I didn't even mark this one.. i put hepatocellular carcinoma because in FA and DIT it mentioned it so I just put it fast seeing that it was antitrypsin deficiency. What is the answer and why
28) 60yo woman 1 yr involuntary rhythmic jerking of right leg and foot. Increased right ankle jerk reflex. Babinski sign + on right. MRI shows 2cm round lesion at interhemispheric fissure at the central sulcus. Dx?
Why not lymphoma? Other options A. Metastatic carcinoma B. Meningioma C. Oligodendroglioma D. Lymphoma
24) 40yo man increased malaise, nausea, abdominal pain and light colored stools. Tenderness to RUQ. Bilirubin:4, ALP: 180, AST: 1500, ALT: 1700. HBeAg, HBsAg, HBV-DNA, IgM anti-HBc antigen: positive. Further observation shows CD8 T cells bind to antigens resulting in liver injury. Where’s antigen from? A. Hepatocytes B. Ito cells C. Stellate cells D. Kupffer cells E. Bile duct epithelium
3) 13yo girl grew 3in over summer. What accounts for increased Ca absorption?
A. Hormones derived from 7-dehyrocholesterol B. Cyclic AMP generated in the enterocytes in response to PTH C. Calcium binding proteins in goblet cells ***Why it can't be the others?
20) 23 yo woman DVT at 6 months pregnant. IV heparin started. 7 days later platelet count: 44,000. Dx? A. Antimegakaryocyte antibodies B. Antiplatelet antibodies C. Heparin induced hemodilution
***Which is the answer and why???
42) 26yo woman 3m pain and stiffness of both hands. Physical exam shows swelling and redness of PIP joints. Xray shows joint space narrowing and marginal erosions of PIP joints. DIP joints spared. Biopsy show?
A. Necrotizing granulomas B. Neutrophilic infiltrates C. Pigmented villonodular synovitis D. Synovial pannus formation E. Urate crystals
**So since it doesn't include DIP i assumed its not rheumatoid arthritis?? so not pannus??? so which one is it??? and why??
76 yo man 30mins severe substernal chest pain while arguing with brother. 3 sublingal nitroglycerin no relieve. 5y h/o ischemic heart disease. P110, R20, BP120/80. Cardiac exam normal. EKG ST elevation at leads I, aVl, and V4-V9. What happened during argument with brother? A. Coronary vasospasm due to a1 B. Coronary vasospasm due to B1 adrenergic C. Increase after load for left ventricle due to B1 D. Negative chronotropc effect of a1
**I have no idea, i assumed increase sympathetic stimulation and for some reason was in between coronary vasospasm due to B1 and after load of B1 but now thinking about it sympathetic stimulates NE release which causes a1 stimulation so I'm an idiot, its that one right?? or which one and why
8) 30 yo man and 24 yo woman genetic counseling. Man’s brother has type 1 oculocutaneous albinism (AR). Single gene disorder 1/40,000 in population. Pedigree shown. What are the odds? A. 1:600 B. 1:100 c. 1:200 d. 1: 40,000 e. 1:4
**Which is the answer and how u got to it??
21) 52 yo man 30mins of substernal chest pain. Pain persisted even w/ 3 doses of sublingual nitroglycerin. P90, BP114/70. Diaphoresis. Lungs clear. S4, ST elevation in inferior leads. IV morphine started. 1 min later develops generalized pruritus. P120, BP90/50. Physical exam facial flushing. What substance cause new symptoms?
A. NO B. Serotonin C. Histamine
**NO Vs. Histamine???
46) Isolated skeletal muscle is isolated w/ glucose bath. Muscle is contracted w/ electrical stimulation. What intracellular increase indicates fatigue? A. ADP B. Inorganic phosphate C. Inosine monophosphate D. Lactate E. pH
**WHYY