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search for anything ⋅ score predictor (โ€œpredict me!โ€)
NBME 21 Answers


Question#2 (reveal difficulty score)
A 6-month-old girl is brought to the ...
GM2 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#3 (reveal difficulty score)
An investigator is studying the efficacy of ...
Flagellin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#4 (reveal difficulty score)
A 67-year-old man comes to the emergency ...
Translation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#7 (reveal difficulty score)
A 30-year-old primigravid woman at 22 weeks' ...
Listeria monocytogenes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#11 (reveal difficulty score)
A 27-year-old primigravid woman at 34 weeks' ...
Schistocytes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#12 (reveal difficulty score)
A 25-year-old nulligravid woman comes to the ...
Endometrial hyperplasia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#14 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...
Streptococcus pneumoniae ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#16 (reveal difficulty score)
A 43-year-old man comes to the physician for ...
Aortic ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#17 (reveal difficulty score)
A 7-year-old girl is brought to a clinic in a ...
Methionine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#18 (reveal difficulty score)
A 61-year-old woman is brought to the ...
Donepezil ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#22 (reveal difficulty score)
A 36-year-old man with AIDS elects to ...
Chemokine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#24 (reveal difficulty score)
A 23-year-old man drinks alcohol heavily on a ...
Fatty change ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#25 (reveal difficulty score)
A 28-year-old man is brought to the emergency ...
Dissecting aneurysm ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#26 (reveal difficulty score)
A 62-year-old man who is a farmer comes to ...
Actinic keratosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#27 (reveal difficulty score)
A 60-year-old man is brought to the emergency ...
Urethral disruption ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#29 (reveal difficulty score)
A 34-year-old man comes to the physician ...
Cluster headache ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#30 (reveal difficulty score)
A newborn has female external genitalia and a ...
Dihydrotestosterone ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#31 (reveal difficulty score)
A 30-year-old woman comes to the office for a ...
Linoleic acid ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#35 (reveal difficulty score)
A 7-year-old boy is brought to the physician ...
Increased blood lead ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#38 (reveal difficulty score)
A 47-year-old woman with aplastic anemia is ...
Amphotericin B ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#39 (reveal difficulty score)
A 33-year-old woman comes to the physician ...
Genital herpes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#40 (reveal difficulty score)
A physician prescribes a recently marketed ...
Phase 4 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#42 (reveal difficulty score)
A 36-year-old woman undergoes a total ...
Hyperplasia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#43 (reveal difficulty score)
A 52-year-old man is brought to the emergency ...
Histamine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#45 (reveal difficulty score)
An 18-year-old man comes to the physician ...
Pyruvate kinase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


genetics pedigree
Question#48 (reveal difficulty score)
A 44-year-old man is admitted to the hospital ...
Increasing cGMP ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#49 (reveal difficulty score)
An 80-year-old woman comes to the emergency ...
Hydrochlorothiazide ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#1 (reveal difficulty score)
A 27-year-old man comes to the physician for ...
Schizoid ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#3 (reveal difficulty score)
A 17-year-old boy returns to the locker room ...
Apocrine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





Question#8 (reveal difficulty score)
A 55-year-old man is diagnosed with renal ...
Cortex ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#10 (reveal difficulty score)
A 42-year-old woman comes to the physician ...
Rosacea ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#11 (reveal difficulty score)
A 22-year-old woman, gravida 1, para 1, is ...
Internal iliac ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#12 (reveal difficulty score)
A 66-year-old woman comes to the physician ...
Diverticulitis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#13 (reveal difficulty score)
A 53-year-old woman with gastroesophageal ...
Omeprazole ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#15 (reveal difficulty score)
A 48-year-old man is brought to the emergency ...
Splenic and left renal ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#17 (reveal difficulty score)
Scientists have identified the flawed gene ...
Mismatch repair ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ











Question#28 (reveal difficulty score)
A 64-year-old woman with type 2 diabetes ...
Gemfibrozil ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#29 (reveal difficulty score)
A healthy 25-year-old man is participating in ...
Alanine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#31 (reveal difficulty score)
A 37-year-old man is brought to the emergency ...
Intercostal ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#32 (reveal difficulty score)
A 17-year-old boy has the acute onset of ...
Lymphocytes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#35 (reveal difficulty score)
A 4-month-old female infant is brought to the ...
Hyponatremia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#36 (reveal difficulty score)
An investigator is conducting a study of ...
Enfuvirtide ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ






Question#42 (reveal difficulty score)
A 26-year-old man with HIV infection comes to ...
Penicillin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#43 (reveal difficulty score)
A 78-year-old woman is brought to the ...
Embolectomy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#44 (reveal difficulty score)
A 75-year-old man has the sudden onset of ...
Parietal lobe, left ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#48 (reveal difficulty score)
A 75-year-old man has fever, back pain, and ...
Enterococcus faecalis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#49 (reveal difficulty score)
A 6-year-old girl is brought to the physician ...
Poxvirus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#1 (reveal difficulty score)
A 30-year-old woman develops dimness of vision
Ethambutol ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ






Question#7 (reveal difficulty score)
A 65-year-old man comes to the physician ...
DNA fragmentation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#10 (reveal difficulty score)
A 30-year-old man has had intermittent severe ...
Cysteine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#11 (reveal difficulty score)
A 50-year-old man is found dead in bed at ...
Arrhythmia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




bilirubin
Question#16 (reveal difficulty score)
A 16-year-old boy is brought to the physician ...
Exercise-induced asthma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#17 (reveal difficulty score)
A 66-year-old woman with pancreatic cancer ...
Short gastric ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#21 (reveal difficulty score)
A screening program is instituted for ...
10% ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#22 (reveal difficulty score)
A 9-year-old boy has mild mental retardation ...
Rhabdomyoma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#25 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Dysplastic nevi ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#26 (reveal difficulty score)
A 19-year-old woman comes to the office ...
Descending colon ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#27 (reveal difficulty score)
A 55-year-old woman with a benign nodule in ...
External carotid ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#31 (reveal difficulty score)
A 28-year-old woman at 18 weeks' gestation ...
Free T4 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#32 (reveal difficulty score)
A 72-year-old man comes to the physician ...
Bleomycin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ










Question#42 (reveal difficulty score)
A 27-year-old primigravid woman at 39 weeks' ...
Shoulder dystocia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#43 (reveal difficulty score)
An undernourished 70-year-old man has fever, ...
Interferon-ฮณ ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#45 (reveal difficulty score)
A 28-year-old man comes to the physician for ...
Fructose ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#46 (reveal difficulty score)
A 38-year-old woman comes to the physician ...
Patent foramen ovale ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#48 (reveal difficulty score)
A 29-year-old woman comes to the physician ...
Baclofen ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

cell_bio cell_transport cell_trafficking
Question#50 (reveal difficulty score)
A 32-year-old woman comes to the emergency ...
Arthropod vector ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#1 (reveal difficulty score)
A 50-year-old woman has azotemia. Renal ...
Uterine cervix ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#3 (reveal difficulty score)
A study was performed that evaluated the ...
Odds ratio ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#5 (reveal difficulty score)
An 11-year-old boy has had persistent pain in ...
Lung ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#6 (reveal difficulty score)
A 55-year-old man comes to the physician ...
Cortisol ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#7 (reveal difficulty score)
A 14-year-old boy is brought to the physician ...
Inhaled glue ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

FA_missing
porphyria phototherapy
Question#9 (reveal difficulty score)
A 60-year-old woman with psoriasis comes to ...
Porphyria cutanea tarda ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

renal SIADH hyponatremia
Question#10 (reveal difficulty score)
A 64-year-old man is evaluated for cough, ...
Hyponatremia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#12 (reveal difficulty score)
A 24-year-old man with a history of drug ...
Heroin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#16 (reveal difficulty score)
A 40-year-old woman who had pneumonia due to ...
Surfactant ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#17 (reveal difficulty score)
A 48-year old man is referred for evaluation ...
Increase in width ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#18 (reveal difficulty score)
A previously healthy 4-week-old male newborn ...
Pyloric stenosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#20 (reveal difficulty score)
A 7-month-old boy is brought to the physician ...
46,XY ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#21 (reveal difficulty score)
A 47-year-old man is treated with colchicine ...
Tubulin polymerization ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#22 (reveal difficulty score)
A 57-year-old woman is brought to the ...
Ninth ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Saline Lymphatic

Question#25 (reveal difficulty score)
An 80-year-old woman cannot concentrate her ...
2.0 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





Question#30 (reveal difficulty score)
A 5-year-old boy is admitted to the hospital ...
ApoC-II ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#32 (reveal difficulty score)
A 19-year-old college student says he hears ...
Risperidone ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#33 (reveal difficulty score)
A female newborn delivered at 26 weeks' ...
Retina ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#36 (reveal difficulty score)
A 45-year-old man comes to the physician ...
Chondrosarcoma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#39 (reveal difficulty score)
A 46-year-old man comes to the physician ...
1/15 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#41 (reveal difficulty score)
A 66-year-old man with stage IV colon cancer ...
Loperamide ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#42 (reveal difficulty score)
A 20-year-old primigravid woman at 12 weeks' ...
Multifactorial ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


renal diuretics GFR
Question#44 (reveal difficulty score)
A 28-year-old woman with chronic renal ...
Furosemide ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

neuro pharm magnesium
process_of_elimination Li_Fraumeni p53
Question#46 (reveal difficulty score)
A 14-year-old girl is brought to the ...
TP53 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#47 (reveal difficulty score)
While lifting weights, a 24-year-old man ...
Strangulation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#49 (reveal difficulty score)
A 76-year-old man comes to the physician ...
Left thalamus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#50 (reveal difficulty score)
A 19-year-old woman is brought to the ...
Scaphoid ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Recent comments ...

... โˆ—nosancuck made a comment (nbme21)
 +79  submitted by nosancuck(100)

Bruh let me tell you a lil secret

PEEP prevents Atelectasis AKA dat LUNG COLLAPSE

Dont be worryin about random words they puts in front of the HIGH YIELD ones

hungrybox  literally LOL'd lmao I love this +17
... โˆ—assoplasty made a comment (nbme21)
 +76  submitted by assoplasty(107)

I think the concept theyโ€™re testing is the increased TBG levels in pregnancy, and not just hyperthyroidism in general.

When screening for hypo/hyperthyroidism, TSH levels are ALWAYS preferentially checked because they are more sensitive to minute differences in T3/T4. Often times TSH levels can demonstrate a change even when T3/T4 levels are in the subclinical range. The only exception to this would be in pregnancy (and I guess maybe liver failure? I doubt they would ask this though). High estrogen levels prevents the liver from breaking down TBG, leading to increased TBG levels in the serum. This binds to free T4, decreasing the amount of available free T4. As a compensatory mechanism, TSH levels are transiently increased and the RATE of T4 production is increased to replenish baseline free T4 levels. However the TOTAL amount of T4 is increased.

The question is asking how to confirm hyperthyroidism in a pregnant woman --> you need to check FREE T4 levels (because they should be normal due to compensatory response). You cannot check TSH (usually elevated in pregnancy to compensate for increased TBG), and you cannot check total T4 levels (will be increased). You got the answer right either way but I think this is a different reasoning worth considering, because they can ask this concept in other contexts of hyper-estrogenism, and if they listed โ€œTSHโ€ as an answer choice that would be incorrect.

hungrybox  Extremely thorough answer holy shit thank u so much I hope you ACE Step 1 +9
arkmoses  great answer assoplasty, I remember goljan talking about this in his endo lecture (dudes a flippin legend holy shit) but it kinda flew over my head! thanks for the break down! +3
whoissaad  you mean total amount of T4 is "not changed"? 2nd para last sentence. +1
ratadecalle  @whoissaad, in a normal pregnancy total T4 is increased, but the free T4 will be normal and rest of T4 bound to TBG. If patient is hyperthyroid, total T4 would still be increased but the free T4 would now be increased as well. +3
maxillarythirdmolar  To take it a step further, Goljan mentions that there are a myriad of things circulating in the body, often in a 1:2 ratio of free:bound, so in states like this you could acutally see disruption of this ratio as the body maintains its level of free hormone but further increases its level of bound hormone. Goljan also mentions that you'd see the opposite effect in the presence of steroids and nephrotic syndromes. So you could see decreased total T4 but normal free T4 because the bound amounts go down. +2
lovebug  Amazing answer! THX +1
an_improved_me  Just to add: Pregnancy is not an exception to using TSH in suspected hyperthyroid pregnant patients (not sure in hypothyroid); you would still get a TSH first, and if its unusually low, you would then proceed to measure T4 (free, total), and so on. https://www.uptodate.com/contents/hyperthyroidism-during-pregnancy-clinical-manifestations-diagnosis-and-causes?search=hyperthyroidism%20in%20pregnancy&source=search_result&selectedTitle=2~150&usage_type=default&display_rank=2#H994499 +1
... โˆ—seagull made a comment (nbme21)
 +62  submitted by seagull(1912)

! I hate these with a burning F***ing passion. Thumbs up if you agree

mcl  Amen brother +2
praderwilli  Every morning: "I think i'll go over glycogen storage diseases, lysosomal storage diseases, and dyslipidemias after questions this afternoon." Every afternoon: Nah +40
mcl  oh my god are you me +2
praderwilli  I recently found a program called Pixorize. It's pretty much Sketchy for biochem. Wish I discovered it sooner cuz it has helped for a lot of the painful things like this! +7
burak  Cherry red spot basically means niemann-pick or tay sachs. Two differences between is: 1- No HSM in Tay Sachs, HSM in niemann-pick. 2- Both of them has muscle weakness but there is hyperreflexia in Tay Sachs, but areflexia in niemann pick disease. In stem cell HSM is not described and hyperreflexia noted. +5
abhishek021196  What is HSM? +1
mysticsoul  HSM - HepatoSplenoMegaly. Cherry red spots think of Tay Sachs, deficient enzyme - HeXosaminidase A, accumulated substrate GM2 ganglioside. Niemann-Pick - Spingomyelinase, Spingomyelin <- which is not even a choice. FA18 Pg 88 +2
lakshmi  Dirty USMLE has an incredible video that makes these super easy to get. +3
djeffs1  @lakshmi Link? +1
... โˆ—lnsetick made a comment (nbme21)
 +59  submitted by lnsetick(106)
  • APocrine = your armpits smell like an APE
  • ceRUMen = thereโ€™s no ROOM in your ears since theyโ€™re full of wax
  • EC-CRYne = when you ECercise, your pores are CRYing
  • SEBaceous = SEBum is SEEPing out of your pores
hungrybox  as an ape i'm offended +39
dr.xx  stop being an ape. evolutionize! +7
dbg  as a creationist i'm offended +13
maxillarythirdmolar  Also, Tarsal/Meibomian glands are found along the rims of the eyelid and produce meibum +
snripper  So why is it apocrine? The dude is EXERCISING when playing football. +6
qball  The question asks about "the characteristic odor" i.e. body odor coming from the APEocrine glands. The Eccrine glands secrete water and electrolytes. +3


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