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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 / ๐Ÿ“–



biochem Lysosomal


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

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


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

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



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

RAPD ophtho

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

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

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

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

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

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

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

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


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

clotting moa

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

biochem repeat

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

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

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

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


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 / ๐Ÿ“–


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


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

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

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

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

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

Question#34 (reveal difficulty score)
A 69-Year-old woman comes to the physician ...
Area marked "D" ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#41 (reveal difficulty score)
A 45-year-old woman comes to the physician ...
Neuraminidase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#48 (reveal difficulty score)
A 67-year-old man comes to the physician for ...
Ubiquitin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#50 (reveal difficulty score)
An 18-year-old woman has severe, painful ...
Tetracycline ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#3 (reveal difficulty score)
A 12-year-old boy with asthma is brought to ...
Bronchiole ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#4 (reveal difficulty score)
A previously healthy 18-year-old man develops ...
Lyme disease ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#7 (reveal difficulty score)
A 29-year-old man has a left testicular mass. ...
Cryptorchidism ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#49 (reveal difficulty score)
A 60-year-old woman is brought to the ...
Gout ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#8 (reveal difficulty score)
An 18-year-old woman comes to the physician ...
50% ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#9 (reveal difficulty score)
A 40-year-old man has pain in the buttocks ...
S-1 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Recent comments ...

... โˆ—aliyah made a comment (nbme19)
 +31  submitted by aliyah(51)

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—blueberriesyum made a comment (nbme19)
 +21  submitted by blueberriesyum(28)

A 70 year old develops a progressive disinhibition syndrome with episodes of emotional outbursts, inappropriate use of language, and socially inappropriate behavior. Where is the most likely damage?

Answer: Frontal lobe disinhibition.

Bilateral amygdala (medial temporal lobe) would've been affected if it was Kluver Bucy Syndrome.

flapjacks  If you know the story of Phineas Gage, it can help +6
helppls  How do you tell the difference from a frontal lobe issue and Kluver Bucy Syndrome? +1
nikitasr27  I would say the emotional and language part. The frontal lobe is very involved in emotions and the limbic system as well as in complex language concepts. Kluver Bucy would lack these aspects as the individual is โ€œindifferentโ€ to everything (no fear, no emotions) just like my ex +3
randi  Kluver-bucy is also marked by specific behaviors like hyperphagia, hyperorality, hypersexuality. Apparently can also be associated with HSV-1 encephalitis FA2019 p499. +1
chaosawaits  What am I looking at? From what viewpoint am I looking? Can anyone identify the labels? I have A is olfactory tract, C/D are optic nerves, E/F are optic tracts, G/H are substantia nigra of midbrain & still I am totally lost. +1
chaosawaits  I imagine that we are viewing the front of the brain from underneath and slightly angled to expose the midbrain more easily. Obviously B is the frontal lobe. But what are I and J? +
an1  @chaosawaits I think J might be the partial lobe. the only thing confusing me is that B is the frontal lobe with the amygdala is actually in the temporal lobe... +
an1  I take that back, I thought it was Kluver body for a second but its just frontal lobe stuff lol +
pakimd  can anyone explain why this is kluver bucy and not frontotemporal dementia? +
doida  it is not kluver, it is frontal lobe dementia +
thatmd  I and J are the temporal lobes +
... 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 +

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