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NBME 16 Answers

skin




Question#8 (reveal difficulty score)
A 55-year-old man comes to the physician ...
Dextromethorphan ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#14 (reveal difficulty score)
Lesch-Nyhan syndrome, an X-linked recessive ...
1/50,000 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#18 (reveal difficulty score)
A screening program is instituted for ...
10% ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#30 (reveal difficulty score)
A 5-year-old boy is brought to the emergency ...
Cerebral edema ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#37 (reveal difficulty score)
A 54-year-old man has an aneurysm in the ...
2.4 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#39 (reveal difficulty score)
A 28-year-old woman comes to the physician ...
Ureter ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#41 (reveal difficulty score)
An 18-year-old man with acute lymphoblastic ...
Amphotericin B ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#48 (reveal difficulty score)
A 12-year-old boy is brought to the physician ...
Abnormal myelin sheaths ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#13 (reveal difficulty score)
A 5-year-old boy is brought to the physician ...
Lysosomes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





Question#50 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Adenylyl cyclase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#5 (reveal difficulty score)
A 45-year-old man is admitted to the hospital ...
Iron ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#9 (reveal difficulty score)
A 53-year-old homeless man with alcoholism is ...
Normal oral flora ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#12 (reveal difficulty score)
An 18-year-old woman comes to the physician ...
Interstitial nephritis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#25 (reveal difficulty score)
A 27-year-old nulligravid woman comes to the ...
Clomiphene ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#30 (reveal difficulty score)
A 54-year-old woman who works as a nurse ...
Interferon gamma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#38 (reveal difficulty score)
A 68-year-old man comes to the physician ...
Right ophthalmic ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#39 (reveal difficulty score)
A 27-year-old woman comes to the physician ...
Reassurance ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





Question#8 (reveal difficulty score)
A 24-year-old woman comes to the physician ...
Tuberous sclerosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#24 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Gastrin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ







Question#40 (reveal difficulty score)
A new antiplatelet agent is developed for the ...
8% ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Poorly_written_question
Question#50 (reveal difficulty score)
A 35-year-old woman participates in a study ...
Day 12 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ







Question#43 (reveal difficulty score)
A 15-year-old boy is brought to the physician ...
Fibrillin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#7 (reveal difficulty score)
A 48-year-old man is referred for evaluation ...
Increase in width ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#2 (reveal difficulty score)
A 66-year-old man has a surgical excision of ...
Kidney ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#16 (reveal difficulty score)
A 53-year-old man is brought to the emergency ...
Microglial cells ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#18 (reveal difficulty score)
A 43-year-old man comes to the physician ...
Rotundum ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#21 (reveal difficulty score)
A 50-year-old man comes to the physician ...
Collagen ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#23 (reveal difficulty score)
A 7-year-old girl is brought to the emergency ...
Right lower ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#24 (reveal difficulty score)
A 16-year-old girl with cystic fibrosis is ...
Vitamin E ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#27 (reveal difficulty score)
A 62-year-old man with unstable angina ...
Left coronary ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#30 (reveal difficulty score)
A 1400-g (3-lb 2-oz) female newborn is ...
Cyclooxygenase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#31 (reveal difficulty score)
A healthy 24-year-old woman participates in a ...
"B" point on the graph ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#32 (reveal difficulty score)
A 31-year-old woman is diagnosed with ...
T lymphocytes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#35 (reveal difficulty score)
A 29-year-old woman comes to the physician ...
Follicular atrophy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





Question#44 (reveal difficulty score)
A 2-year-old boy is brought to the physician ...
Heteroplasmy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#1 (reveal difficulty score)
A previously healthy 59-year-old man comes to ...
DNA polymerase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#5 (reveal difficulty score)
A 51-year-old man who is a farmer comes to ...
Leukemoid reaction ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

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

Question#7 (reveal difficulty score)
An 80-year-old woman who develops fever and ...
Pseudomonas aeruginosa ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#10 (reveal difficulty score)
A 66-year-old man is brought to the emergency ...
Increasing cGMP ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#15 (reveal difficulty score)
A 62-year-old man comes to the physician for ...
Contemplation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#16 (reveal difficulty score)
A 56-year-old man is scheduled for repair of ...
Ligamentum flavum ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#19 (reveal difficulty score)
An otherwise healthy 60-year-old man comes to ...
Scattered shrunken cells ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#20 (reveal difficulty score)
A 28-year-old woman, gravida 2, para 1, comes ...
Venous hypertension ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#26 (reveal difficulty score)
A 35-year-old man with a longstanding history ...
Parietal ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Pharm_Cal
Question#32 (reveal difficulty score)
A 35-year-old woman is given 500 mg of drug X ...
8 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#34 (reveal difficulty score)
A 30-year-old woman comes to the physician ...
Oligodendrocytes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#36 (reveal difficulty score)
A 55-year-old man comes to the physician ...
Volume depletion ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#38 (reveal difficulty score)
A 3-year-old boy is brought to the physician ...
Feces-contaminated soil ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

erections libido
Question#43 (reveal difficulty score)
A 23-year-old man comes to the physician ...
Pudendal nerves ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#44 (reveal difficulty score)
Two days after undergoing a right hip ...
Dead space ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#1 (reveal difficulty score)
A 22-year-old man comes to the physician ...
46,XXY ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#4 (reveal difficulty score)
A 6-month-old girl is brought to the ...
Facial ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#9 (reveal difficulty score)
A 64-year-old man is evaluated for cough, ...
Hyponatremia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#19 (reveal difficulty score)
A healthy 25-year-old man lives at 10,000 ...
Hematocrit ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#26 (reveal difficulty score)
A 65-year-old man with peripheral vascular ...
Jejunum ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



pharm pharmacology
Question#31 (reveal difficulty score)
A 62-year-old woman with recurrent non-small ...
Tubulin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#34 (reveal difficulty score)
A 42-year-old man with hepatitis C undergoes ...
Chronic inflammation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#36 (reveal difficulty score)
A 43-year-old woman who has been diagnosed ...
"B" label on the CT ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#38 (reveal difficulty score)
A 65-year-old woman with hypertension comes ...
Labetalol ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#44 (reveal difficulty score)
A 9-year-old boy is brought to the physician ...
Protein structure ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#3 (reveal difficulty score)
A couple seeks genetic counseling because of ...
0% ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#5 (reveal difficulty score)
A 60-year-old man with no history of bleeding ...
Kallikrein formation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#11 (reveal difficulty score)
An investigator is conducting a study of ...
Enfuvirtide ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#18 (reveal difficulty score)
An investigator is studying bacterial ...
Transcription ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#21 (reveal difficulty score)
A 3-year-old boy is brought to the emergency ...
Procollagen synthesis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#24 (reveal difficulty score)
A 6-month-old boy with a history of recurrent ...
T-lymphocyte deficiency ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#35 (reveal difficulty score)
A 68-year-old woman comes to the physician ...
Superior mesenteric ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#41 (reveal difficulty score)
A 23-year-old woman, who was diagnosed with ...
Substance P ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#11 (reveal difficulty score)
A 70-year-old African American woman comes to ...
Gender ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#12 (reveal difficulty score)
A 20-year-old woman who works as a secretary ...
Migraine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#22 (reveal difficulty score)
A 60-year-old man comes to the physician for ...
Aortic valve stenosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#28 (reveal difficulty score)
A 35-year-old woman comes to the physician ...
Pericarditis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#50 (reveal difficulty score)
A 67-year-old man comes to the physician ...
Cigarette smoking ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#8 (reveal difficulty score)
A pale 62-year-old man has increasing fatigue ...
Hairy cell leukemia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#27 (reveal difficulty score)
A 4-month-old boy is brought to the physician ...
Chediak-Higashi syndrome ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#28 (reveal difficulty score)
A 62-year-old man comes to the physician ...
Prostate ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#49 (reveal difficulty score)
A 16-year-old girl is brought to the ...
Eclampsia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#50 (reveal difficulty score)
A 75-year-old woman with osteopenia comes to ...
Normal aging ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#39 (reveal difficulty score)
A 19-year-old man who plays college ...
Myxoma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#49 (reveal difficulty score)
A 25-year-old man is brought to the emergency ...
Peutz-Jeghers ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#4 (reveal difficulty score)
A previously healthy 27-year-old woman comes ...
Costochondritis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


psych
Question#37 (reveal difficulty score)
A 35-year-old man is referred for psychiatric ...
Dysthymic disorder ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#19 (reveal difficulty score)
A 69-year-old African American woman has ...
Irbesartan ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#38 (reveal difficulty score)
A 58-year-old African American man with ...
Sildenafil ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#39 (reveal difficulty score)
A 27-year-old man with acute myelocytic ...
Mesna ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#49 (reveal difficulty score)
A 38-year-old woman undergoes laparoscopic ...
Ondansetron ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#17 (reveal difficulty score)
A 12-year-old girl who recently immigrated to ...
Praziquantel ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#30 (reveal difficulty score)
A 51-year-old woman receives the diagnosis of ...
Phenoxybenzamine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#33 (reveal difficulty score)
A 70-year-old woman is brought to the ...
Cimetidine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#41 (reveal difficulty score)
A 15-year-old Native American boy is brought ...
Physostigmine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#26 (reveal difficulty score)
A 5-year-old girl is brought to the physician ...
Ethosuximide ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#42 (reveal difficulty score)
A 19-year-old woman is brought to the physician by
Risperidone ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#17 (reveal difficulty score)
A 67-year-old woman comes to the physician ...
Low sensitivity ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#46 (reveal difficulty score)
A study is conducted to assess 32 patients in ...
31 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#9 (reveal difficulty score)
A 25-year-old man develops a temperature of ...
Evaporation of sweat ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




hsv
Question#5 (reveal difficulty score)
A 20-year-old woman comes to the physician ...
Herpes simplex virus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#33 (reveal difficulty score)
A 25-year-old man is brought to the emergency ...
Ureteral calculus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#25 (reveal difficulty score)
A 20-year-old woman is found to have a blood ...
Chronic pyelonephritis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#22 (reveal difficulty score)
A 21-year-old woman comes to the physician ...
Fluoxetine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#3 (reveal difficulty score)
A previously health 67-yeaer-old woman comes ...
Influenza virus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#6 (reveal difficulty score)
Hantavirus strain A grows poorly at a ...
Large ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Recent comments ...

... โˆ—bingcentipede made a comment (nbme16)
 +21  submitted by bingcentipede(351)

Kid had a viral URI then took aspirn -> Reye syndrome, a hepatic encephalopathy. There is increased ammonia production because of the liver damage, leading to hyperammonemia. This gets to the brain, is ocnverted to glutamine (an osmolyte). This causes the brain swelling.

It's not E) viral encephalitis because it implies the virus is directly causing the encephalitis. Instead, the viral infection -> aspirin -> liver damage -> ammonia -> crosses BBB -> converted to glutamine -> draws in water -> cerebral edema

https://step1.medbullets.com/gastrointestinal/107080/hepatic-encephalopathy

cheesetouch  FA18 p 384 +
... โˆ—zincy7 made a comment (nbme16)
 +20  submitted by zincy7(28)
  • Burning Abdominal Pain hours after eating = Gastric ulcer
  • Black stools for 2 days = ???
  • Refractory to OTC Antacids and H2 Blockers
  • Sweating and Low BP
  • Pancreatic Mass = most likely GASTRINOMA
LOGIC

Immunohistochemical labeling uses antibodies as markers for what they want to find. In this case, we're suspecting gastrin given the symptoms

Note: You should revise the function, stimulation, and site of release for each of the hormones mentioned as well

REFERENCE: Zollinger-Ellison Syndrome

bingcentipede  Black stool because blood in the GI tract? +2
passplease  I was tempted to pick insulin, because of the orthostatics and sweating that could resemble hypoglycemic episodes. Why are those present in a gastrinoma? +3
deberawr  @passplease it's possible that increased gastrin -> peptic ulcers -> perforation -> shock -> sympathetic nervous system overload -> sweating and hypotension +
jsanmiguel415  Black stool = melena = bleeding above the ligament of trietz from ulcers +1
rina  @passplease according to amboss gastrinomas can cause steatorrhea and malabsorption, in addition to anemia from GI bleeding. that might explain the light headedness and low-ish bp. +
jj375  Zollinger Ellison Syndrome --> causes duodenal ulcers that are bleeding causing melena and the low blood volume (symptoms of light headed and low BP). I would guess that sweating is from what @deberawr said of the increased sympathetics from the low blood volume +4
cheesetouch  FA18 347 zollinger ellison +
... โˆ—cassdawg made a comment (nbme16)
 +20  submitted by cassdawg(1752)

This is metastatic renal cell carcinoma (FA2020 p605) for the following reasons:

  • Polycythemia - this is the primary clue, as it is associated with ectopic EPO (erythropoitin) secretion in paraneoplastic syndromes (FA2020 p228), which can be caused by pheochromocytoma, renal cell carcinoma, heptocellular carcinoma, hemangioblastoma and leiomyoma. Of these, only liver and kidney would be a choice given and hepatocellular carcinoma is incorrect because he did not have any associated finding of jaundice, hepatomegaly, ascites, or anorexia (FA2020 p392). Plus, the liver does not commonly metastasize to brain whereas kidney does (FA2020 p223)
  • Hypercalcemia - this is likely indicative of PTHrP secretion, and renal cell carcinoma is one of the cancers that can do this. However, this is fairly nonspecific as there are many cancers that can secrete PTHrP.
  • Heamaturia - suggestive of kidney/urinary tract involvement
  • Negative for carcinoembryonic antigen - this is a nonspecific marker mainly for colon and pancreatic cancers (FA2020 p226)
hungrybox  WOW. Amazing explanation. Great work!! +
nbmeanswersownersucks  Additionally the histo looks like the Clear cell type of RCC. The large white/clear spaces with "chicken-wire" vessels and stroma between them. +11
hecticsurreyguy  Any idea as to how the " positive epithelial membrane antigen" fits into it being renal cell carcinoma? Also to add to the reasons for it being Kidney, the image that they provide is a classic example of renal cell carcinoma cells. Take note of how the cells look to almost be vacuolated or completely clear of any cytosolic material apart from the nucleus. This the classic presentation for renal "clear cell" carcinoma. +
... โˆ—medninja made a comment (nbme16)
 +13  submitted by medninja(20)

I cell disease โ€”inherited lysosomal storage disorder (autosomal recessive); defect in N-acetylglucosaminyl-1-phosphotransferase --> failure of the Golgi to phosphorylate mannose residues (decrease mannose-6-phosphate) on glycoproteins --> ย proteins are secreted extracellularly rather than delivered to lysosomes

iury_r1beiro  FA 2020 p 47 +1
an1  this is I-cell disease. we can tell because it's in a child (indicating AR as those occur in younger ages for the most part), he has recurrent infections, HSM (because the lipids, carbs, and proteins aren't broken down in the lysosome, they enter the blood and may deposit in the liver, spleen, heart, and bone resulting in enlargement), the presence of a NAG is right from FA. these proteins are not tagged with manose-6-phosphate and so don't go to the lysosome for degradation, lysosomal levels also increase in the blood. patients often present just like hurlers, + claw hand and kyphoscolosis. +


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