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NBME 19 Answers

Question#1 (reveal difficulty score)
53 yo woman w/GERD. Diet change, stress ...
Omeprazole ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#7 (reveal difficulty score)
48 yo woman, 2 weeks of fever and stool with ...
Entamoeba histolytica ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#34 (reveal difficulty score)
12 yo girl unable to walk for 5 days but is ...
Conversion disorder ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#35 (reveal difficulty score)
5 yo boy, R eye pain for 1 week; retinal exam ...
Retinal cells ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#36 (reveal difficulty score)
36 yo woman presents to ED after believing ...
Panic disorder ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#5 (reveal difficulty score)
38 yo woman, 6 months depressed mood, joint ...
Lyme disease ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#6 (reveal difficulty score)
24 yo man, generalized tonic-clonic seizure; ...
Psychogenic polydipsia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#8 (reveal difficulty score)
Retinoic acid receptors and HOX gene products ...
Transcription factors ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#17 (reveal difficulty score)
Scurvy symptoms associated with decreased ...
Prolyl hydroxylase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#46 (reveal difficulty score)
Decreased pulmonary artery pressure ...
cGMP ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#9 (reveal difficulty score)
Cells most responsible for graft rejection?
T lymphocytes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#19 (reveal difficulty score)
30 yo man and 24 yo woman; best estimate that ...
1 in 600 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#22 (reveal difficulty score)
Blood gas values: arterial O<sub>2</sub> ...
Anemia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#28 (reveal difficulty score)
40 yo man, 1 month increasing malaise, ...
Hepatocytes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#29 (reveal difficulty score)
15 yo girl receives bone marrow transplant; ...
Nonautologous donor ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#39 (reveal difficulty score)
45 yo man, lost outdoors in the Rocky ...
Kidney ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#40 (reveal difficulty score)
25 yo woman requests prenatal diagnosis at 12 ...
Chorionic villi sampling ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#42 (reveal difficulty score)
Study conducted to determine effects of drug ...
Tubocurarine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#46 (reveal difficulty score)
52 yo man, sudden onset of substernal chest pain
Histamine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#13 (reveal difficulty score)
26 yo woman after jejunoileal bypass for ...
Vitamin A ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#14 (reveal difficulty score)
11 yo boy, right mid-thigh pain for 2 weeks; ...
Ewing sarcoma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#15 (reveal difficulty score)
60 yo woman, 1 year of episodic involuntary ...
Meningioma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#27 (reveal difficulty score)
52 yo woman prescribed cisplatin for ...
Odansetron ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#46 (reveal difficulty score)
24 yo woman; renal oxygen consumption found ...
Tubular reabsorption ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#0 (reveal difficulty score)
During an experiment, an isolated skeletal ...
pH ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

clotting moa

Question#0 (reveal difficulty score)
Investigator studying spermatogenesis...tight ...
Sertoli ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#0 (reveal difficulty score)
Graph shows rate of breakdown of skeletal ...
Allosteric activator ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#0 (reveal difficulty score)
Investigator does an experiment... third ...
Thymus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#0 (reveal difficulty score)
A 2-year-old boy with cerebral palsy is ...
obturator ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#0 (reveal difficulty score)
An 11-year-old boy has repeated episodes of ...
NADPH oxidase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#0 (reveal difficulty score)
A 35-year-old man comes to the physician to ...
1:4 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#40 (reveal difficulty score)
Immediately after cerebral infarction, a ...
A (Broca's area) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

FA19p490 stroke neuro

picture_frame_vertebre picture_frame_vertebrae
Question#23 (reveal difficulty score)
A 22-year-old man get separate from a group ...
Area postrema ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#24 (reveal difficulty score)
A 62-year-old woman has an abdominal aortic ...
Cholesterol emboli ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#11 (reveal difficulty score)
A 48-year-old man comes to the physician for ...
Budd-Chiari syndrome ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#17 (reveal difficulty score)
During a study of the digestion of protein ...
Enteropeptidase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#8 (reveal difficulty score)
An investigator is developing a new drug that ...
Crypt cells ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#27 (reveal difficulty score)
A 6-year-old girl has the recent onset of ...
Procollagen, type I ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#6 (reveal difficulty score)
A 24-year-old woman comes to the gynecologist ...
Endometriosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#26 (reveal difficulty score)
A 2-year-old boy is brought to the physician ...
Bruton agammaglobinemia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#39 (reveal difficulty score)
A 52-year-old woman begins treatment with ...
Ondansetron ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#4 (reveal difficulty score)
A 50-year-old man comes to the physician ...
Acetaminophen ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#49 (reveal difficulty score)
A 30 year old man is brought to the ED 30 min ...
sympathomimetic agent ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#48 (reveal difficulty score)
An investigator is studying the efficacy of ...
Prions ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Recent comments ...

... โˆ—aliyah made a comment (nbme19)
 +30  submitted by aliyah(49)

If a germ cell or somatic cell had the original mutation, then there's an increased risk for cancer in other parts of the body too. If only retinal cells in one eye is mutated, only that one eye is at risk for cancer.

... โˆ—ajguard26 made a comment (nbme19)
 +21  submitted by ajguard26(55)

Chorionic villi sampling is the taking of genetic material within in the chorionic villi of the placenta. Chorionic sampling is done when a patient is at high risk for chromosomal abnormalities (previous pos. tests, 35yo or older, family hx.) during the 10-13 weeks of pregnancy.

Confined placental mosaicism results when the C.V.S. testing comes back back showing a trisomy, but all subsequent testing (and the fetus itself) have normal chromosomal counts. This may be due to either a trophoblastic mutation, or by "trisomic rescue," in which trisomic cells that were supposed to be in the fetus are confined to the placenta to prevent an abnormal fetus.

cbay0509  thank you +
shakakaka  Why It's unreadable.. +4
randi  unfortunately you have to have an account to unscramble most responses +
chaosawaits  Wow, a +16 response (rarely see those) that we can't read... FML +2
... โˆ—ajguard26 made a comment (nbme19)
 +20  submitted by ajguard26(55)

So although Misoprostol DOES increase mucus production and is gastro-protective (and in FA does state that it decreases acid production), thereby decreasing symptoms and aiding in healing, omeprazole is the "more correct" choice. This is because omeprazole is a proton-pump inhibitor, which will act directly on the proton pumps of the stomach and decrease the offending agent more than the misoprostol will. Therefore, it is the first line drug for GERD.

an_improved_me  These questions can be so frustrating... I mean most people know PPIs are your go to when considering GERD / peptic ulcer disease... but when you speicfically add "both relieving Sx ... promoting healing", why even add a drug that specifically and directly does both... I mean PPIs promote healing, but so indirectly. This hurts my heart +4
chaosawaits  Seriously, FA2019, p393 specifically states misoprostol "increases production and secretion of gastric mucous barrier and decreases acid production" What does it say for omeprazole, you might ask? "Irreversibly inhibits H+/K+ ATPase in stomach parietal cells" and that's it. +
leap1608  if u focus on the question it asks the healing of esophageal mucosa. prostagladins protect gastric mucosa? PPI`S would perhaps prevent the metaplasia of chronic gerd and heal the esophageal mucosa +
... โˆ—cassdawg made a comment (nbme19)
 +20  submitted by cassdawg(1763)

So I hate this question because you can know what the diagnosis is and still miss it.

TL;DR: This is lead poisioning, so there is basophilic stippling in a peripheral blood smear [BUT ringed sideroblasts would also be found in the bone marrow]

Why this is lead poisoning: (FA2020 p425)

  • Microcytic Anemia (caused by lead inhibition of ferrocheletase and ALA dehydratase)
  • Environmental exposure (ammunition at the range, he is an officer)
  • GI effects (crampy abdominal pain)
  • Neurological effects (headache, irritability, distractability, forgetful, motor weakness)

Why it is NOT the other answers:

  • Auer rods - characteristic of acute myelogenous leukemia which would present with pancytopenias (his WBCs are normal) along with circulating myeloblasts on peripheral smear; median age onset 65 years and he has no risk factors
  • Oval Macrocytes - in macrocytic anemias (B12 or folate deficiency), this is microcytic as indicated by MCV
  • Pleomorphic lymphocytes - occur in chronic lymphocytic leukemias and infectious mono, both which have different symptomotologies
  • Ringed sideroblasts - are from lead poisoning but are in the bone marrow
  • Scistocytes - characteristic RBC which has been through a clogged vessel and sheared off, found in microangiopathic hemolytic anemias (MAHAs) like thrombotic microangiopathies like TTP and HUS (typically normocytic anemia and different presentation; a question would likely give you more info on the thrombolytic pathway if they wanted you to choose this; we didn't even get a platelet count here)
  • Target Cells: found in HbC disease (glutamic acid to lysine in hemoglobin, causes extravascular hemolysis), liver disease, asplenia, and Thalassemia (deletions in either alpha or beta chain of hemaglobin, causes anemia that would be present from childhood and would not have neuro symptoms)
ftr_dr_bowowers  thank you! +3
chaosawaits  just take my upvote you beautiful sonofabitch! +
chaosawaits  So if FRC decreases, TLC decreases as well, which rules out E. +
chaosawaits  Above comment not related to this question +

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