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NBME 15 Answers

Question#6 (reveal difficulty score)
A 7-year-old boy is brought to the physician ...
Virion release ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#9 (reveal difficulty score)
A healthy 3-year-old boy has a cleft lip and ...
Multifactorial ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#11 (reveal difficulty score)
A 9-year-old boy has mild mental retardation ...
Tuberous sclerosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#19 (reveal difficulty score)
A 65-year-old man with a history of ischemic ...
33% ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#24 (reveal difficulty score)
A 3-year-old girl is brought to the physician ...
Interferon-gamma receptor ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#32 (reveal difficulty score)
A 4-day-old male newborn who was born at home ...
First ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#35 (reveal difficulty score)
One-half hour after an uncomplicated vaginal ...
Oxytocin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#37 (reveal difficulty score)
A 36-year-old man who is heterozygous for an ...
LDL receptor ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#38 (reveal difficulty score)
A 23-year-old woman comes to the physician ...
Oculomotor nerve ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#39 (reveal difficulty score)
An investigator is designing a study to ...
Stratification ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#44 (reveal difficulty score)
A 59-year-old man comes to the physician ...
Imatinib ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#46 (reveal difficulty score)
A 6-year-old boy with severe mental ...
0.2 to 0.5 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#48 (reveal difficulty score)
A 22-year-old man is brought to the emergency ...
Deep fibular (peroneal) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#49 (reveal difficulty score)
A 23-year-old woman comes to the physician ...
Glucokinase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#3 (reveal difficulty score)
A 2-year-old girl is brought to the emergency ...
Atropine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#6 (reveal difficulty score)
A 56-year-old woman comes to the physician ...
Helicobacter pylori ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





Question#20 (reveal difficulty score)
A 30-year-old man is brought to the physician ...
Porphobilinogen deaminase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

neuro
Question#21 (reveal difficulty score)
A 43-year-old woman comes to the physician ...
Complex partial ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





leishmania
Question#29 (reveal difficulty score)
A 2-month-old male infant is brought to the ...
Glycine receptor ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#31 (reveal difficulty score)
A 24-year-old woman with Marfan syndrome ...
Hypervolemia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#32 (reveal difficulty score)
A 25-year-old primigravid woman at 25 weeks' ...
Prematurity ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

glutamine
Question#39 (reveal difficulty score)
A 43-year-old man with a 10-year history of ...
Decreased glutathione ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#40 (reveal difficulty score)
A 4-year-old boy is brought to the physician ...
Cytoskeleton ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#41 (reveal difficulty score)
A 45-year-old man comes to the physician for ...
Mitral regurgitation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#43 (reveal difficulty score)
A 37-year-old woman is brought to the ...
Cardiogenic ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#47 (reveal difficulty score)
A 75-year-old man with chronic obstructive ...
C5a ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#49 (reveal difficulty score)
A study was begun in the 1950s to determine ...
Cohort study ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#6 (reveal difficulty score)
A 50-year-old man comes to the physician for ...
Medullary ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#7 (reveal difficulty score)
A 1-year-old boy is brought to the physician ...
RNA splice error ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#9 (reveal difficulty score)
A newborn undergoes surgical repair of ...
Endoderm ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#24 (reveal difficulty score)
A 28-year-old African American man comes to ...
Ethnicity ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





oncology hodgkin lymphoma mutation
biochemistry
Question#47 (reveal difficulty score)
A 2-month-old boy is brought to the physician ...
Peroxisomes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#48 (reveal difficulty score)
A paper says, "We chose the sample size to ...
5%, Type I error ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#3 (reveal difficulty score)
A 51-year-old man with a 5-year history of ...
Hematuria ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

pharyngeal_arch digeorge

Question#8 (reveal difficulty score)
A newborn delivered at 28 weeks' gestation is ...
Lung elastic recoil ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#9 (reveal difficulty score)
A 40-year-old woman with breast cancer is ...
Occipital lobe ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



neuro
Question#25 (reveal difficulty score)
A couple has two children with osteogenesis ...
Germline mosaicism ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#32 (reveal difficulty score)
A 70-year-old woman is found dead in her bed ...
Hypertrophy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#38 (reveal difficulty score)
A 25-year-old woman comes to the physician ...
Thrombocytopenia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#42 (reveal difficulty score)
A 4-year-old boy with a karyotype of 47,XY+21 ...
Excess lymphoblasts ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#44 (reveal difficulty score)
A 72-year-old woman comes to the physician ...
Osteomalacia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#0 (reveal difficulty score)
A previously healthy 26-year-old woman comes ...
External hemorrhoid ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#0 (reveal difficulty score)
A 50-year-old man comes to the emergency ...
Anemia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#0 (reveal difficulty score)
Following a stroke, a 68-year-old man has a ...
H (Wernicke's area) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#40 (reveal difficulty score)
Influenza virus strains are characterized by ...
HA ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#2 (reveal difficulty score)
An investigator conducts a study of the ...
Proteasome ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#5 (reveal difficulty score)
A 6-year-old girl is brought to the physician ...
Glutamine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ







Question#30 (reveal difficulty score)
A 43-year-old woman is admitted to the ...
Hippocampus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#33 (reveal difficulty score)
A 45-year-old man with an ulcer in the ...
Diaphragm ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#34 (reveal difficulty score)
A previously healthy 25-year-old woman comes ...
Germ cells ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#39 (reveal difficulty score)
A 3-year-old girl is brought to the physician ...
Dynein ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#42 (reveal difficulty score)
A 22-year-old man comes to the emergency ...
Median ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#45 (reveal difficulty score)
A 70-year-old man has a 4-month history of ...
Pancreatic enzymes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#47 (reveal difficulty score)
A 50-year-old man is brought to the physician ...
"D" label in the image ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ













Question#47 (reveal difficulty score)
A 30-year-old woman comes to the physician ...
Serotonin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#3 (reveal difficulty score)
A 3-year-old boy with chronic otitis media is ...
Low blood solubility ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#8 (reveal difficulty score)
A 14-year-old boy has fatigue, intermittent ...
Vitamin B12 (cobalmin) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#22 (reveal difficulty score)
A 21-year-old woman at 30 weeks' gestation is ...
Cyclooxygenase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#41 (reveal difficulty score)
A 56-year-old woman is brought to the ...
1000 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#45 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Collecting duct ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#10 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Internal iliac ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#31 (reveal difficulty score)
A 50-year-old woman comes to the physician ...
Endothelin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#5 (reveal difficulty score)
An 18-year-old man comes to the physician ...
Prolactin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#18 (reveal difficulty score)
A 10-year-old girl with sickle cell disease ...
Salmonella ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Heme
Question#25 (reveal difficulty score)
A 62-year-old woman comes to the physician ...
Multiple myeloma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#31 (reveal difficulty score)
A 75-year-old woman comes to the physician ...
Lentigo maligna ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#36 (reveal difficulty score)
A food handler has a fresh furuncle on his ...
Vomiting ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#25 (reveal difficulty score)
A 67-year-old man comes to the physician ...
Burning ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#32 (reveal difficulty score)
A 23-year-old woman is brought to the ...
Heroin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#13 (reveal difficulty score)
A 3-year-old girl is brought to the physician ...
Thyroid follicles ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#3 (reveal difficulty score)
A 19-year-old woman is brought to the ...
Olanzapine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#37 (reveal difficulty score)
A 51-year-old woman undergoes dilation and ...
Succinylcholine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#43 (reveal difficulty score)
A 35-year-old metal worker collapses after ...
Amyl nitrite ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#26 (reveal difficulty score)
A 69-year-old man with benign prostatic ...
Bethanechol ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#18 (reveal difficulty score)
A 34-year-old woman who is a scientist is ...
Potassium iodide ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#28 (reveal difficulty score)
A 19-year-old woman comes to the physician ...
Doxycycline ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#4 (reveal difficulty score)
A study is conducted to assess a new prenatal ...
99% ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



aspirin
Question#9 (reveal difficulty score)
An 18-year-old woman is brought to the ...
Bleeding time ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#22 (reveal difficulty score)
A 32-year-old man has a 3-month history of ...
Decreased smoking ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#27 (reveal difficulty score)
A 55 year old woman with colon cancer and a ...
Apoptosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

reproductive repro
Question#1 (reveal difficulty score)
A 26 year old woman comes to the physician ...
oral metronidazole ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#12 (reveal difficulty score)
A 62-year-old man comes to the physician ...
Macrophages ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

reproductive repro Repro
Question#35 (reveal difficulty score)
A 62-year-old man undergoes cystoscopy for ...
Ureteric orifices ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#13 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...
Antisocial ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#27 (reveal difficulty score)
A 55-year-old woman comes to the physician because
Supraspinatus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#26 (reveal difficulty score)
A 75-year-old man has a cerebral infarction. ...
Liquefaction ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#4 (reveal difficulty score)
A 22-year-old basketball player who uses ...
Pneumothorax ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#7 (reveal difficulty score)
A 26-year-old man develops loose, foul ...
Celiac disease ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#42 (reveal difficulty score)
an investigator is studying the age of ...
60 years ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#13 (reveal difficulty score)
a 38-year-old man comes to the physician ...
omeprazole ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



lead_poisoning
Question#25 (reveal difficulty score)
A 3-year-old girl is brought to the physician ...
Ferrochelatase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Recent comments ...

... โˆ—cassdawg made a comment (nbme15)
 +20  submitted by cassdawg(1752)

Deoxyhemoglobin has a higher pKa than oxyhemaglobin and thus will accept hydrogen ions more readily. This is important in the ability to "carry" CO2 as the main mechanism of CO2 transport is actually conversion of CO2 to HCO3- (CO2 + H2O -> HCO3- + H+), thus deoxyhemaglobin carries the H+ while HCO3- is transported in the plasma to the lungs. Carbaminohemaglobin is actually only about 20% of the CO2 trasnport and CO2 dissolved as CO2 is 10%; trasnport as HCO3- is around 70% of the CO2 transport.

Here is another image of the process.

Another important aspect of the process to take note of that they like to ask about is the chloride shift. Chloride moves the opposite direction as HCO3- in the RBC. Thus at tissues where we are generating HCO3- from CO2 and need to pump it out of the cell, chloride moves into the cell.At the alveoli where we need to pump HCO3- back into the RBC to turn it into CO2, chloride moves out of the cell.

Other answers:

  • 2,3BPG will bind and stabilizes deoxyhemaglobin making it less attracted to oxygen, shifting the hemaglobin dissosiation curve right.
  • Deoxyhemaglobin has a higher capacity to form carbanimohemaglobin
  • Deoxyhemaglobin has a higher pKA than oxyhemaglobin (this is why it can accept hydrogen ions more readily)
  • Competition for binding site is not a major mechanism for the ability to carry CO2 as most CO2 is "carried" by conversion to HCO3-
  • Nitric oxide binding is not a mechanism of CO2 carry.
i_hate_it_here  <-- +5
pakimd  @cassdawg thank you for explaining so well along with explaining all the answer options. +2
... โˆ—andro made a comment (nbme15)
 +18  submitted by andro(264)

First question : They tell us its a lymphocytic leukemia

Second question : Deciphering whether it is a B cell or T cell.

The cells have no surface bound Ig M ,Ig G or cytoplasmic chains for these antibodies , but have a rearranged gene segment( meaning active ) for the T cell Receptor . So the Cells are T Cells

Third question : Now that we know that they are T Cells , we want to know whether they are CD4 or CD 8 positive

The cells in the clinical vignette lack both CD4 and CD 8 ( double negative ) According to how T cells normally develop - They start of as being double negative ( i.e not expressing CD4 or CD 8) in the subcapsular region and progressively become
- positive for both CD 4 and CD 8 in the cortex
- and eventually acquire the TCR and CD3 by the time they get to the medulla

These cells therefore must T lymphocyte thymocytes localised to the cortex

i_hate_it_here  FA2020 pg: 102 +1
makingstrides  Yeah, that's what I chose too @dawgtor. But I think when the cells are made in the bone marrow, they don't have the MHC classes/ TCR either. When they get into the thymic cortex, they gain those and undergo positive selection. This is from FA2020 page 102. Correct me if I am wrong. +1
victorlt14  The thymocyte (T cell precursor, not T cell quite yet) gets in the subcapsular zone of the cortex with no CD4/CD8. It took me longer to be sure it was a cell of T lineage though. Looking back I think it should've been rather easy to recognise that since the cell line has a T cell receptor it is of T cell lineage. +
... โˆ—cassdawg made a comment (nbme15)
 +17  submitted by cassdawg(1752)

Here is my take: a ventricular septal defect in infancy allows for left to right shunting of blood in the ventricles. This causes an increased pressure in the right ventricle (due to more blood being pushed into it) and a decreased pressure in the left ventricle. Because there is more blood in the pulmonary circulation from the shunt, I think the left atrial pressure would also be increased in an early VSD.

SO when you repair the VSD, the left ventricle pressure will be increased compared to when the shunt was present (it is no longer losing blood), the right ventricle pressure will be decreased (it is no longer getting blood from the shunt), and the left atrial pressure will be decreased (there is no longer overload of the pulmonary system returning to the left atrium).

FA2020 p298

epiglotitties  ily cassdawg +12
i_hate_it_here  epiglotitties ๐Ÿ˜‚ +
... โˆ—cassdawg made a comment (nbme15)
 +17  submitted by cassdawg(1752)

Here, we want to know loading dose which is equal to the volume of distribution x target concentration in plasma.

So our loading dose = 1.81L/kg x 10mg = 18.1mg/kg

She is a 55kg person so 18.1mg/kg x 55kg = 995.5 mg which approximates to 1000mg total loading dose.

Important Pharm Equations to Remember

cassdawg  10mg/L * sorry +1
cheesetouch  fa2018 p229 +2


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