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NBME 20 Answers

Block 1/Question#1
A 37-year-old nurse is accidentally stuck with a needle used ...
Inhibits reverse transcriptase

Block 1/Question#2
A mother who has toxoplasmosis gives birth to an asymptomatic ...
Antitoxoplasma IgM antibody concentrations

Block 1/Question#3
A 48-year-old man comes to the physician for a routine ...
Upregulation of the LDL receptors

Block 1/Question#4
A 50-year-old man is brought to the emergency department by ...
Formic acid

Block 1/Question#5
A 24-year-old African American man comes to the physician ...
Pseudofolliculitis barbae

Block 1/Question#6
A 16-year-old student has uncontrollable sleepiness, falling ...
Direct transition from wakefulness to REM sleep

Block 1/Question#7
A 5-year-old girl with AIDS develops a progressive ...
Thymidine kinase

Block 1/Question#8
A 10-year-old girl is brought to the physician by her mother ...
Breast bud development

Block 1/Question#9
A 50-year-old man is brought to the physician by his wife ...
Pick disease

Block 1/Question#10
A 77-year-old woman has been having difficulty fastening ...
C7-T1 foraminal stenosis

Block 1/Question#11
The sequence surrounding the first two exons of the human ...
Disruption of normal splicing by creation of a new 3′ splice site

Block 1/Question#12
A 72-year-old woman with dysphagia is undergoing surgical ...
Right kidney

Block 1/Question#13
A 6-week-old girl is brought to the physician by her mother ...
Immature lower esophageal sphincter

Block 1/Question#14
A 28-year-old man who is a migrant worker comes to the clinic ...
Psoas major

Block 1/Question#15
A 30-year-old man who completed a successful course of ...
Adjustment disorder with anxiety

Block 1/Question#16
A 30-year-old woman with multiple sclerosis comes to the ...
Pons

Block 1/Question#17
A 50-year-old woman comes to the physician because of a ...
Drug effect

Block 1/Question#18
A 36-year-old man comes to the physician because he has not ...
Urine output: increased; Urine potassium: increased

Block 1/Question#19
A 60-year-old man comes to the physician because of a 6-week ...
Urine Na+: increased; Serum osmolality: decreased

Block 1/Question#20
An 8-year-old boy is evaluated for ventricular systolic ...
Coarctation of the aorta

Block 1/Question#21
A 75-year-old woman comes to the physician because of a ...
Multinucleated giant cells and neutrophil infiltrates

Block 1/Question#22
A 38-year-old woman comes to the physician because of a 3-day ...
Vagus

Block 1/Question#23
A 34-year-old man who is HIV positive is brought to the ...
CD4+ T lymphocytes

Block 1/Question#24
A 50-year-old man comes to the physician because of a ...
Omeprazole

Block 1/Question#25
A 25-year-old primigravid woman at 42 weeks’ gestation is ...
Phosphoinositide hydrolysis

Block 1/Question#26
Serum cholesterol concentrations are measured as part of a ...
16%

Block 1/Question#27
A 53-year-old woman comes to the physician because of a ...
Schistosoma mansoni

Block 1/Question#28
A previously healthy 16-year-old girl comes to the physician ...
Trichomonas vaginalis

Block 1/Question#29
During an experiment, an investigator isolates an abnormal ...
Lysine

Block 1/Question#30
A 33-year-old woman comes to the emergency department 1 hour ...
Lunate

Block 1/Question#31
A 66-year-old man has had fatigue, shortness of breath, and ...
Focal pulmonary fibrosis

Block 1/Question#32
A 56-year-old woman is brought to the emergency department ...
Placement of the central line via the left internal jugular vein

Block 1/Question#33
A 17-year-old girl comes to the emergency department because ...
Mitochondrial

Block 1/Question#34
A strain of Escherichia coli produces a temperature-sensitive ...
Missense

Block 1/Question#35
A 70-year-old man dies of coronary artery disease. He had a ...
Spastic hemiparesis on the right

Block 1/Question#36
A 56-year-old man is admitted to the hospital after an ...
Rhabdomyolysis

Block 1/Question#37
A 1-month-old male newborn is brought to the emergency ...
Na+: 132; K+: 3.2; Cl: 90; HCO3: 37

Block 1/Question#38
A 9-year-old girl is brought to the physician because of poor ...
Diverticulum of the roof of the embryonic oral cavity

Block 1/Question#39
A 3-month-old boy is brought to the office by his mother ...
Lateral to the inferior epigastric artery and superior to the inguinal ligament

Block 1/Question#40
Monoclonality of neoplastic cells in endometrial carcinoma ...
X chromosome-linked isoenzymes

Block 1/Question#41
A 45-year-old man has fever, chills, dysuria, and a tender, ...
Escherichia coli

Block 1/Question#42
A 60-year-old man has two-pillow orthopnea, severe dyspnea, ...
Jugular venous pressure of 12 mm Hg

Block 1/Question#43
A randomized clinical trial is conducted to compare wound ...
Neither procedure is superior

Block 1/Question#44
A 35-year-old woman with newly diagnosed hypertension comes ...
MR angiography of the renal arteries

Block 1/Question#45
A 2-year-old boy is brought to the physician because of ...
Amino Acids: decreased; Glucose: decreased; Phosphate: decreased; HCO3–: decreased

Block 1/Question#46
A 55-year-old woman comes to the physician for a follow-up ...
Cholecalciferol

Block 1/Question#47
A 60-year-old woman with type 2 diabetes mellitus is brought ...
Rupture of a papillary muscle

Block 1/Question#48
An otherwise healthy 4-month-old girl is brought to the ...
Spontaneous involution

Block 1/Question#49
A 56-year-old man comes to the physician because of a 6-month ...
Fibromuscular hyperplasia of arterioles

Block 1/Question#50
A 26-year-old man undergoes an abdominal exploratory ...
Splenic

Block 2/Question#1
A 17-year-old girl comes to the emergency department because ...
Speak with the patient and her parents about the findings

Block 2/Question#2
Following a wedding reception that was attended by 75 people, ...
Norovirus

Block 2/Question#3
An investigator compares the DNA sequences of a group of ...
5′ CCGG

Block 2/Question#4
A 56-year-old woman has frequently burned herself while ...
Syrinx of the central region of the spinal cord from C-4 to T-5

Block 2/Question#5
A 32-year-old woman has had fecal incontinence since giving ...
Damage to the anal sphincter

Block 2/Question#6
An 18-year-old boy has just been diagnosed with ...
50%

Block 2/Question#7
A 30-year-old man comes to the physician because of a 3-month ...
Increased osteoclast maturation and activity

Block 2/Question#8
Three elderly residents of an assisted living facility in ...
Legionella pneumophila

Block 2/Question#9
An otherwise healthy 16-year-old girl comes to the physician ...
Cold, dry air

Block 2/Question#10
A 70-year-old woman is transferred to a rehabilitative ...
Activity level before the fracture

Block 2/Question#11
A female newborn delivered at 36 weeks' gestation is in ...
Incomplete formation of pleuroperitoneal membrane

Block 2/Question#12
An 80-year-old man with type 2 diabetes mellitus is brought ...
Pelvic splanchnic

Block 2/Question#13
A 25-year-old woman comes to the physician because of a 2-day ...
A phospholipid (cardiolipin) on charcoal particles

Block 2/Question#14
A 23-year-old woman has had fever, hypotension, and ...
Streptococcus pneumoniae

Block 2/Question#15
A 55-year-old man comes to the physician because of ...
Dextromethorphan

Block 2/Question#16
A 10-year-old boy with mild mental retardation is brought to ...
Tuberous sclerosis

Block 2/Question#17
A 57-year old man has a hemoglobin concentration of 18.5 ...
Chronic obstructive pulmonary disease

Block 2/Question#18
A 65-year-old man is brought to the emergency department ...
ST-segment elevation

Block 2/Question#19
A 66-year-old man is brought to the emergency department 30 ...
Cigarette smoking

Block 2/Question#20
A 19-year-old man who is a college student is brought to the ...
Subcutaneous crepitus

Block 2/Question#21
A 25-year-old woman comes to the physician 2 days after ...
Granulomas containing stellate microabscesses

Block 2/Question#22
A 44-year-old woman comes to the physician for a follow-up ...
Ubiquitin ligase

Block 2/Question#23
Which of the following changes in the cardiovascular system ...
Increased basal systolic blood pressure

Block 2/Question#24
A patient with a 1-week history of diarrhea has reduced ...
Decreased arterial Pco2

Block 2/Question#25
A 14-year-old girl is brought to the physician because of a ...
Mitochondrial tRNALeu

Block 2/Question#26
A male newborn is found to have a decreased blood thyroxine ...
Thyroid hormone-binding globulin deficiency

Block 2/Question#27
A 38-year-old African American man with recently diagnosed ...
It should play a role because the efficacy of certain classes of medications varies among different ethnicities

Block 2/Question#28
At a postnatal checkup, a 6-week-old female newborn weighs 20 ...
Annular pancreas

Block 2/Question#29
A 25-year-old woman has a flu-like illness (fever, myalgias, ...
Picornavirus

Block 2/Question#30
A 78-year-old man is brought to the emergency department by ...
Cortisol

Block 2/Question#31
A 25-year-old man comes to the physician 8 hours after the ...
Rupture of an intervertebral disc

Block 2/Question#32
A 12-year-old girl is brought to the physician by her mother ...
Osteoblasts

Block 2/Question#33
A study is conducted to assess the effect of a new screening ...
Lead-time

Block 2/Question#34
A 28-year-old man has excessive thirst and polyuria. The ...
Hypothalamus

Block 2/Question#35
A 36-year-old woman comes to the office because of a 1-month ...
Splenomegaly

Block 2/Question#36
A 31-year-old man has a large, yellow, soft mass deeply ...
Liposarcoma

Block 2/Question#37
A 28-year-old woman of Eastern European Jewish decent comes ...
Recombinational double-stranded DNA break repair

Block 2/Question#38
A 50-year-old woman with a restrictive pulmonary disorder ...
Functional residual capacity: decreased; Residual volume: decreased; Vital capacity: decreased

Block 2/Question#39
A 29-year-old man comes to the physician because of a 1-week ...
Absence of peptidoglycan

Block 2/Question#40
A 70-year-old man has a 3-month history of weakness and a ...
Squamous cell carcinoma

Block 2/Question#41
Purified serum antibodies elicited by immunization with ...
Proteins X and Y express the same epitopes

Block 2/Question#42
A previously healthy 32-year-old woman is brought to the ...
Preload

Block 2/Question#43
An 18-year-old woman comes to the physician because she has ...
Ovaries

Block 2/Question#44
A 43-year-old woman, gravida 2, para 1, at 10 weeks' ...
Nuchal translucency (fetal ultrasound): increased;
Pregnancy-associated Plasma Protein (maternal serum): decreased;
Human Chorionic Gonadotropin (maternal serum): increased


Block 2/Question#45
A new antiplatelet agent is developed for the prevention of ...
8%

Block 2/Question#46
A physician prescribes a newly marketed drug to 45 patients. ...
Discontinue the new drug in affected patients and file MedWatch reports on the FDA's Web site

Block 2/Question#47
A 35-year-old man comes to the physician to discuss donating ...
1:4

Block 2/Question#48
A sedentary 50-year-old man with hypertension comes to the ...
Antidepressant therapy

Block 2/Question#49
An 82-year-old woman is brought to the physician because of a ...
Decreased slope of diastolic depolarization

Block 2/Question#50
A 27-year-old woman comes to the physician because of a ...
Pheochromocytoma

Block 3/Question#1
The frequency of an autosomal recessive disease in a ...
1/25

Block 3/Question#2
A 23-year-old woman is brought to the emergency department ...
Xanthine oxidase

Block 3/Question#3
A 45-year-old woman has a thyroidectomy because of asymmetric ...
Calcitonin

Block 3/Question#4
An 18-year-old woman comes to the physician because of fever, ...
Reactive T lymphocytes

Block 3/Question#5
A 35-year-old man comes to the physician because of a 2-month ...
Methotrexate

Block 3/Question#6
A new drug has the following effects on the activity of the ...
Pathway labeled 'H' (Conversion of Leukotriene A4 to Leukotriene B4

Block 3/Question#7
A 10-year-old boy has a palpable mass in the ventral midline ...
Endoderm of foramen caecum

Block 3/Question#8
A 12-year-old girl is brought to the physician for a ...
Polyubiquitination

Block 3/Question#9
A 62-year-old man comes to the physician because of pain in ...
Prostate

Block 3/Question#10
A 59-year-old man develops fatigue and decreased appetite 3 ...
Hemolysis

Block 3/Question#11
A 3-year-old boy is brought to the physician because of a ...
Heterozygous mutation in the ankyrin gene

Block 3/Question#12
A 46-year-old man has dyspnea, orthopnea, and a midsystolic ...
Mitral regurgitation

Block 3/Question#13
A 45-year-old woman develops proteinuria and hematuria. She ...
Tubulointerstitial nephritis

Block 3/Question#14
During a clinical study, an investigator tests a new drug for ...
Increase the sample size

Block 3/Question#15
A 23-year-old woman, who was diagnosed with Sjögren syndrome ...
Substance P

Block 3/Question#16
A 41-year-old woman with systemic lupus erythematosus is ...
Ask the attending physician to obtain informed consent

Block 3/Question#17
A 45-year-old man comes to the emergency department because ...
Schizoid personality disorder

Block 3/Question#18
An 18-year-old woman comes to the physician to request ...
50%

Block 3/Question#19
A 23-year-old man comes to the physician because of a 1-month ...
Area labeled ‘B’ (Mitochondrion)

Block 3/Question#20
A 67-year-old woman comes to the physician for a health ...
Low sensitivity

Block 3/Question#21
A newborn is born with a lethal chromosome defect. He is ...
Feed by whatever means necessary to maintain comfort

Block 3/Question#22
In patients with breast cancer, metabolically stable agonists ...
Gonadotropin by the pituitary gland

Block 3/Question#23
A 50-year-old woman is brought to the emergency department by ...
pKa: 6.0; Protein binding in plasma: 20%; Volume of distribution at steady state: 1 L/kg

Block 3/Question#24
A 2-month-old girl is brought to the emergency department by ...
Thyroid function tests

Block 3/Question#25
A 4-week-old infant is brought to the emergency department ...
Hypertrophic pyloric stenosis

Block 3/Question#26
A 3-month-old boy is brought to the physician because of ...
Mannose 6-phosphate

Block 3/Question#27
A 55-year-old man with type 2 diabetes mellitus, ...
Pravastatin

Block 3/Question#28
A 23-year-old woman who is 6 months pregnant develops deep ...
Antiplatelet antibodies

Block 3/Question#29
An 83-year-old man is brought to the emergency department ...
Early septic shock

Block 3/Question#30
A 22-year-old woman who recently emigrated from rural Mexico ...
Obstruction of the right interventricular foramen (foramen of Monro)

Block 3/Question#31
A 62-year-old woman comes to the physician because of ...
β-Tubulin

Block 3/Question#32
A 54-year-old woman with terminal metastatic pancreatic ...
Nonmaleficence

Block 3/Question#33
A 31-year-old woman receives a prescription for tetracycline ...
Formation of complexes with mineral ions

Block 3/Question#34
A 22-year-old woman comes to the emergency department because ...
Release of bacterial products

Block 3/Question#35
A 51-year-old man has the acute onset of fever and ...
Cytomegalovirus infection

Block 3/Question#36
A 4-year-old boy has had fever, abdominal cramping, and ...
Shigella sonnei

Block 3/Question#37
A 62-year-old man with alcohol-induced liver disease develops ...
Spironolactone

Block 3/Question#38
A 23-year-old man with a 3-year history of schizophrenia is ...
Psychogenic polydipsia

Block 3/Question#39
A 19-year-old woman has severe refractory pustular acne that ...
Teratogenic effects in the embryo

Block 3/Question#40
Two days after admission to the hospital because of ...
Do not proceed with the transfusion

Block 3/Question#41
A 2-year-old child undergoes resection of the right kidney ...
Increase in glomerular size

Block 3/Question#42
A 13-year-old girl has an episode of severe cellular ...
Epstein-Barr virus genome

Block 3/Question#43
A 71-year-old man comes to the physician because of a 6-month ...
Cilostazol

Block 3/Question#44
A 56-year-old man is brought to the emergency department 30 ...
Capillary hydrostatic: increased; Interstitial hydrostatic: increased; Interstitial oncotic: decreased

Block 3/Question#45
A 39-year-old man reports bright red spots on the toilet ...
Constipation

Block 3/Question#46
Removal of the thymus at birth results in severely impaired ...
Thymic lymphocytes produced before thymectomy are long-lived

Block 3/Question#47
A 60-year-old woman has prolonged apnea following general ...
Succinylcholine

Block 3/Question#48
A 48-year-old woman comes to the physician because of a ...
Hypothyroidism

Block 3/Question#49
A 92-year-old woman who was recently admitted to a nursing ...
Atrophy of dermal collagen

Block 3/Question#50
A 62-year-old man comes to the physician because of a 1-week ...
Agonist at γ-aminobutyric acid B (GABAB) receptors

Block 4/Question#1
A 32-year-old man comes to the physician because of a 3-month ...
Tissue: testicle; Effect: estradiol production

Block 4/Question#2
A study is conducted to identify healthy women at risk for ...
Liver

Block 4/Question#3
A 23-year-old woman comes to the physician for a follow-up ...
Collagen synthesis

Block 4/Question#4
A 20-year-old man comes to the physician stating that food ...
Olfactory

Block 4/Question#5
Immediately after a cerebral infarction, a 62-year-old ...
Area labeled ‘A’ (Broca’s area)

Block 4/Question#6
A 51-year-old man develops diaphoresis, tachycardia, and a ...
Alcohol withdrawal

Block 4/Question#7
A 33-year-old woman with HIV infection is brought to the ...
Non-Hodgkin lymphoma

Block 4/Question#8
A 58-year-old man is brought to the emergency department ...
Hypertension

Block 4/Question#9
A previously healthy 37-year-old woman comes to the physician ...
Tumor of the adrenal zona fasciculata

Block 4/Question#10
A 65-year-old woman who has a 25-year history of chronic ...
Hydroxylation of proline

Block 4/Question#11
A 37-year-old man who is HIV positive comes to the physician ...
Nortriptyline

Block 4/Question#12
An investigator is conducting a randomized, double-blind, ...
Analyze all nonadherent participants according to the group of the study to which each was randomized

Block 4/Question#13
A 62-year-old woman comes to the physician because of a ...
Bronchogenic carcinoma

Block 4/Question#14
A 60-year-old man has a round, semitransparent nodule on his ...
Basal cell carcinoma

Block 4/Question#15
A 45-year-old man is undergoing a surgical procedure. Which ...
Decreasing respiratory rate

Block 4/Question#16
An investigator wishes to determine the effectiveness of a ...
Ductal ion reabsorption is more efficient at low flow rates

Block 4/Question#17
A previously healthy 55-year-old man has recently been ...
Renal artery stenosis

Block 4/Question#18
A 35-year-old man comes to the physician because of a 6-month ...
Gastrin

Block 4/Question#19
A 55-year-old man with severe emphysema comes to the ...
Percussion: hyperresonant; Tactile fremitus: decreased; Expiratory phase: prolonged

Block 4/Question#20
A 5-year-old boy is brought to the physician for a follow-up ...
Hypophosphatemia

Block 4/Question#21
A 47-year-old woman comes to the physician because of a ...
Contact with parakeets

Block 4/Question#22
A 35-year-old man is given cyclosporine following a liver ...
Decreased synthesis of interleukins

Block 4/Question#23
A 45-year-old woman who is intubated and mechanically ...
β-Glucan carbohydrates in the cell wall

Block 4/Question#24
A 27-year-old man comes to the physician because of weakness ...
Deep branch of the ulnar nerve at the hook of the hamate bone

Block 4/Question#25
A 52-year-old man is brought to the emergency department ...
Increased total peripheral resistance and decreased cardiac output

Block 4/Question#26
A 33-year-old man comes to the physician because of a 3-week ...
Rectus femoris

Block 4/Question#27
An investigator is studying patients with West Nile virus ...
Case series

Block 4/Question#28
A 78-year-old man dies of chronic congestive heart failure. ...
Failure of the Na+–K+ pump

Block 4/Question#29
A 15-year-old girl is brought to the physician by her mother ...
Doxycycline

Block 4/Question#30
A 32-year-old woman is brought to the emergency department 20 ...
Arterial laceration

Block 4/Question#31
A 48-year-old man is brought to the emergency department 12 ...
Cl-: 96 mEq/L; HCO3-: 8 mEq/L

Block 4/Question#32
A 55-year-old man comes to the physician because of a 2-month ...
Partial oxidation of fatty acids

Block 4/Question#33
A 65-year-old woman with cardiovascular disease is found to ...
Increased bile salt

Block 4/Question#34
A 20-year-old man is brought to the physician by his mother ...
How frightening for you to see your son like this. Do you have any idea about what might be causing his behavior?""

Block 4/Question#35
A 62-year-old man comes to the physician for a follow-up ...
Contemplation

Block 4/Question#36
A 25-year-old woman is brought to the emergency department ...
Factitious disorder

Block 4/Question#37
A 16-year-old girl with cystic fibrosis is brought to the ...
Vitamin E

Block 4/Question#38
A 45-year-old man comes to the physician because of ...
Tumor necrosis factor

Block 4/Question#39
A 30-year-old woman develops serum sickness following ...
C3a

Block 4/Question#40
A 6-month-old girl is brought to the emergency department by ...
Ornithine transcarbamylase

Block 4/Question#41
A 56-year-old man with a 20-year history of chronic back pain ...
Naloxone

Block 4/Question#42
A 65-year-old woman dies 6 months after the onset of severe ...
Meningeal

Block 4/Question#43
A physician is assigned to a search and rescue team ...
Negative nitrogen balance

Block 4/Question#44
A 45-year-old man comes to the office for counseling prior to ...
Starchy foods

Block 4/Question#45
A 12-year-old boy is brought to the physician for further ...
Terminal components of complement

Block 4/Question#46
A 28-year-old woman at 32 weeks' gestation comes to the ...
Obstructive uropathy

Block 4/Question#47
A 61-year-old man has erectile dysfunction due to spinal cord ...
Area labeled ‘D’ (Corpus cavernosum)

Block 4/Question#48
A 24-year-old man comes to the emergency department because ...
Lipoprotein lipase

Block 4/Question#49
A 23-year-old woman sustains significant blood loss in a ...
Direct antiglobulin test

Block 4/Question#50
A previously healthy 16-year-old girl is brought to the ...
Prescribe antibiotics without notifying her parents

Recent comments ...

... amorah made a comment on nbme20/block3/q#35 (A 51-year-old man has the acute onset of fever and...)
 +15  upvote downvote
submitted by amorah(27)

Fever -> rule out left ventricular failure TMP-SMX prophylaxis -> rule out Pneumocystis jiroveci Kidney transplant but no WBC/RBC in urine -> rule out transplant rejection

Leaving CMV and atypical mycobacterium as the remaining two options. CMV is more likely in a transplant patient.

... hayayah made a comment on nbme20/block1/q#40 (Monoclonality of neoplastic cells in endometrial...)
 +14  upvote downvote
submitted by hayayah(399)

Neoplasia is new tissue growth that is unregulated, irreversible, and monoclonal.

Clonality can be determined by glucose-6-phosphate dehydrogenase (G6PD) enzyme isoforms. G6PD is X-linked.

*For more information check out Ch. 3 Neoplasia in Pathoma

hello  This is great, thank you.
breis  Pathoma ch. 3 pg 23 "Basic Principles"
charcot_bouchard  Shoutout to Imam Satter! Without him this question wasnt possible for me to answer in 10 sec.
... strugglebus made a comment on nbme20/block1/q#17 (A 50-year-old woman comes to the physician because...)
 +12  upvote downvote
submitted by strugglebus(69)

Nowhere have I been able to find why the hell this is a thing.

yotsubato  Its not in FA, Sketchy, or Pathoma, or U world. I knew it wasnt cancer because its bilateral. And Diabetes made no sense to me. So I just threw down Drug effect and walked away.
breis  same^^^
feliperamirez  The only possible explanation I think is that she was under a K sparing diuretic, such as spironolactone (which would lead to gynecomastia).
... justgettinby made a comment on nbme20/block1/q#24 (A 50-year-old man comes to the physician because of...)
 +12  upvote downvote
submitted by justgettinby(12)

Itraconazole requires the acidic environment of the stomach to be absorbed. Omeprazole inhibits the H+/K+ pump of the stomach, thereby decreasing the acidity of the stomach. So when the patient takes Omeprazole and Itraconazole together, Itraconazole won't be absorbed into the body. That's why it has no effect.

It's recommended to take medications at least 2 hours prior to taking an antacid.

necrotizingfasciitis  Just adding support to the above explanation: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3671798/
pakimd  do all azoles or just itraconazole only requires an acidic environment to be absorbed?
... hayayah made a comment on nbme20/block2/q#32 (A 12-year-old girl is brought to the physician by...)
 +12  upvote downvote
submitted by hayayah(399)

A big thing here too is noticing that the ALP is decreased. Osteoblast activity is measured by bone ALP. I think that was the main focus here and not that you necessarily need to know the CBFA1 gene mutation.

sympathetikey  Exactly. That's the only way I got to the answer.
pakimd  isnt increased alk phos consistent with increased osteoblastic activity?
champagnesupernova3  A defect with chondrocytes would cause an short limbs like in achondroplasia so those are ruled out
... hayayah made a comment on nbme20/block3/q#44 (A 56-year-old man is brought to the emergency...)
 +11  upvote downvote
submitted by hayayah(399)

LV stopped working, pressure backed up into pulm circuit. Pulm circuit roughly is made of 3 "parts" - the capillaries, interstitial space, and the alveoli.

In cardiogenic shock, the extra blood increases capillary hydrostatic pressure, driving fluid into the interstitial space. Compared to the alveoli, the interstitial space now has more fluid (thus more interstitial hydrostatic pressure and less oncotic pressure due to ratio of fluid to protein), and as a result of this unbalancing of forces, fluid moves into the alveoli --> pulmonary edema.

masonkingcobra  https://www.ncbi.nlm.nih.gov/core/lw/2.0/html/tileshop_pmc/tileshop_pmc_inline.html?title=Figure%204.1.%20Mechanisms%20of%20enhanced%20transcapillary%20filtration%20in%20response%20to%20elevations%20in%20arterial%20or%20venous%20pressure.&p=BOOKS&id=53445_fig4.1.jpg
... celeste made a comment on nbme20/block2/q#6 (An 18-year-old boy has just been diagnosed with...)
 +10  upvote downvote
submitted by celeste(32)

While the lifetime risk in the general population is just below 1%, it is 6.5% in first-degree relatives of patients and it rises to more than 40% in monozygotic twins of affected people. Analyzing classic studies of the genetics of schizophrenia done as early as in 1930s, Fischer concludes that a concordance rate for psychosis of about 50% in monozygotic twins seems to be a realistic estimate, which is significantly higher than that in dizygotic twins of about 10–19% (ncbi.nlm.nih.gov/pmc/articles/PMC4623659/#ref3)

imnotarobotbut  How is one supposed to know this before having read this article?
imgdoc  This question falls under the either you know it or you dont category. It isnt in FA or Uworld
jaxx  So why would these A-holes put it on there as if prepping for this exam isn't stressful enough :-|
doodimoodi  Lol just why seriously
champagnesupernova3  This was mentioned in the Kaplan behavioral videos
... jotajota94 made a comment on nbme20/block3/q#1 (The frequency of an autosomal recessive disease in a...)
 +9  upvote downvote
submitted by jotajota94(10)

Use the Hardy-Weinberg equation

  1. Take the square root of 1/1600, and that will give you the frequency of the recessive allele = 1/40.
  2. Calculate the frequency of the dominant allele with p+q=1, which is p= 0.975.
  3. They are telling you to calculate the frequency of the disease carriers, which is with the equation 2pq.
  4. They want only the disease carriers in which deletion is present. To calculate this, use the q value (1/40) and multiply by 80% in this should give you 0.02.
  5. Finally, calculate for 2Pq 2 (0.975)(0.02)= 0.04 = 1/25.
yex  Nice! ...and we are supposed to read the stem and do all this in a minute or so? :-/
charcot_bouchard  Allele frequency 1/40. so carrier freq 1/20. 80% of 1/20 is 1/25 (80/100 x 1/20)
dickass  Ah feck, 2pq got me
... monoloco made a comment on nbme20/block4/q#17 (A previously healthy 55-year-old man has recently...)
 +9  upvote downvote
submitted by monoloco(53)

As a rule of thumb, if you give someone an ACE inhibitor and they get a problem, they had renal artery stenosis (usually bilaterally, or so we were taught at our med school). Probably has to do with decreased GFR thanks to decreased Angiotensin II–selective vasoconstriction of the efferent arteriole => decreased sodium delivery to macula densa => increased renin release.

... xxabi made a comment on nbme20/block4/q#46 (A 28-year-old woman at 32 weeks' gestation comes to...)
 +9  upvote downvote
submitted by xxabi(91)

Also for those of you who are totally clueless like me, urinary tract obstruction = obstructive uropathy.

... strugglebus made a comment on nbme20/block2/q#20 (A 19-year-old man who is a college student is...)
 +9  upvote downvote
submitted by strugglebus(69)

Bronchophony= pneumonia Expiratory stridor= tracheobronchial obstruction (mass/foreign body) Inspiratory stridor = laryngeal obstruction Succussion splash= test for pyloric stenosis

When there is a fractured rib it will cause a trauma pnemothorax which can cause air to escape and become trapped under the skin leading to crepitus.

charcot_bouchard  Actually when a fractured rib puncture lung then it cause sc emphysema.
... hayayah made a comment on nbme20/block1/q#34 (A strain of Escherichia coli produces a...)
 +8  upvote downvote
submitted by hayayah(399)

Missense mutations involve a nucleotide substitution resulting in changed amino acids. Sometimes the effects of missense mutations may be only apparent under certain environmental conditions; such missense mutations are called conditional mutations. Many missense mutations result in proteins that are still functional, at least to some degree.

Also, all the other answers would probably leave you with either a greatly altered or non-functional protein.

thefoggymist  I chose nonsense because I thought it'll make the enzyme shorter (since less bonds = more heat liable = can't work at 42 degrees) but yea, probably won't work even at 30 if it's an early nonsense.
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