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NBME 22 Answers

RAAS
Question#2 (reveal difficulty score)
A 28-year-old man has recurrent pancreatitis ...
Decreasing VLDL ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#5 (reveal difficulty score)
A 10-month-old girl is brought to the ...
Naloxone ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

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

Question#7 (reveal difficulty score)
Two patients, a 54-year-old man (Patient X) ...
Loading dose ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#8 (reveal difficulty score)
A 16-year-old girl has pain and tingling in ...
Cervical rib ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#9 (reveal difficulty score)
A 54-year-old man has an aneurysm in the ...
2.4 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#11 (reveal difficulty score)
A 6-month-old boy has recently been diagnosed ...
Sphingomyelin degradation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#12 (reveal difficulty score)
During the first week of life, a male newborn ...
21-Hydroxylase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#14 (reveal difficulty score)
A 57-year-old woman comes to the physician ...
Trigeminal neuralgia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#16 (reveal difficulty score)
An Rh-negative woman, gravida 3, para 2, has ...
O, Rh-negative ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#17 (reveal difficulty score)
A 27-year-old man is brought to the emergency ...
Eversion ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#18 (reveal difficulty score)
A 13-year-old boy is brought to the physician ...
Reassurance ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#19 (reveal difficulty score)
An 11-year-old boy has had pain in his right ...
Ewing sarcoma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#21 (reveal difficulty score)
A 30-year-old man comes to the physician ...
Polycystin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#24 (reveal difficulty score)
A 48-year-old man with renal artery stenosis ...
Testicular artery ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#27 (reveal difficulty score)
During a clinical study, 15 patients with ...
Azathioprine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#29 (reveal difficulty score)
A 28-year-old man comes to the emergency ...
Jejunum ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#30 (reveal difficulty score)
A 42-year-old woman is brought to the ...
Temporal lobe ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#31 (reveal difficulty score)
A 60-year-old woman comes to the physician ...
Lung cancer ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#32 (reveal difficulty score)
A 17-year-old boy is brought to the emergency ...
Hypokalemia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#33 (reveal difficulty score)
A 32-year-old woman begins to hyperventilate ...
Cerebral blood flow ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ







Question#40 (reveal difficulty score)
A 45-year-old man with chronic pancreatitis ...
Pancrelipase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#41 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...
Gender and body habitus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#44 (reveal difficulty score)
A 52-year-old man with a history of alcoholic ...
Superior rectal ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#45 (reveal difficulty score)
A 16-year-old girl is brought to the ...
Diuretics ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#49 (reveal difficulty score)
A 17-year-old primigravid woman at 16 weeks' ...
Azithromycin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#50 (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 previously healthy 28-year-old man comes to ...
Nephrolithiasis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#6 (reveal difficulty score)
A 52-year-old man is brought to the emergency ...
4 Months ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

erections libido penis

immuno abo_incompatibility complement
erections penis
anatomy
cAMP
Question#12 (reveal difficulty score)
A 42-year-old woman with frequent heartburn ...
cAMP ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#13 (reveal difficulty score)
A 5-year-old boy who lives on a farm has had ...
Yersinia enterocolitica ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#15 (reveal difficulty score)
A 62-year-old woman comes to the physician 3 ...
Carcinoma of the breast ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#16 (reveal difficulty score)
A 60-year-old man is brought to the emergency ...
Prostate adenocarcinoma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#17 (reveal difficulty score)
Ten healthy human subjects are given a new ...
Phase 1 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#19 (reveal difficulty score)
A 50-year-old man comes to the physician 3 ...
Calcium ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#20 (reveal difficulty score)
A 26-year-old nulligravid woman comes to the ...
Hypothalamus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#22 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Adenylyl cyclase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#23 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Reduviid bug ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#24 (reveal difficulty score)
A 72-year-old man is given ketorolac for pain ...
Acute renal failure ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#25 (reveal difficulty score)
A 37-year-old woman undergoes excision of a ...
Angiogenesis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#28 (reveal difficulty score)
A 65-year-old man comes to the physician for ...
Ulnar and tibial ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#30 (reveal difficulty score)
A 40-year-old woman comes to the physician ...
Multifactorial ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#31 (reveal difficulty score)
An unimmunized 1-year-old boy is admitted to ...
Phase variation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#32 (reveal difficulty score)
A 54-year-old man who works in a delicatessen ...
Schwann cells ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#34 (reveal difficulty score)
A 30-year-old man and a 24-year-old woman ...
1 in 600 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#36 (reveal difficulty score)
Which of the following drug effects is the ...
Anticholinergic ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#38 (reveal difficulty score)
Following a stroke, a patient is hoarse and ...
Lateral medulla ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#39 (reveal difficulty score)
A 22-year-old woman comes to the office ...
Cardiomyopathy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ






Question#45 (reveal difficulty score)
An 86-year-old man who lives in a skilled ...
Dextromethorphan ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#47 (reveal difficulty score)
A 22-year-old woman who is at 16 weeks' ...
Down syndrome ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#49 (reveal difficulty score)
A physician is unable to communicate "bad ...
Countertransference ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#1 (reveal difficulty score)
A 35-year-old man comes to the physician ...
C7 nerve root ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#3 (reveal difficulty score)
An obese 45-year-old woman with type 2 ...
Diarrhea ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ











Question#14 (reveal difficulty score)
A 57-year-old woman comes to the physician 2 ...
Intercostal ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#15 (reveal difficulty score)
An 18-year-old man comes to the physician 10 ...
C8 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#17 (reveal difficulty score)
A 50-year-old man with chronic gastritis is ...
Helicobacter pylori ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





Question#22 (reveal difficulty score)
A study is conducted to assess the prevalence ...
Chi-square test ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#23 (reveal difficulty score)
A 45-year-old woman comes to the physician ...
25% ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#27 (reveal difficulty score)
A 45-year-old man with poorly controlled type ...
Enterococcus faecalis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#28 (reveal difficulty score)
A 12-year-old girl who recently immigrated to ...
Praziquantel ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#29 (reveal difficulty score)
A 45-year-old man with end-stage renal ...
Bicarbonate ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#30 (reveal difficulty score)
Which of the following is required for the ...
Glutamine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#33 (reveal difficulty score)
A 22-year-old man comes to the physician ...
47,XXY ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#34 (reveal difficulty score)
The risk for hemorrhagic stroke from drug X ...
Case-control study ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#37 (reveal difficulty score)
A 35-year-old man with bronchial asthma ...
Increase in cAMP ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#38 (reveal difficulty score)
A 73-year-old man comes to the physician with ...
Blood pressure ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#39 (reveal difficulty score)
A 52-year-old man with stable angina pectoris ...
Headache ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#41 (reveal difficulty score)
A 56-year-old man develops brief episodes of ...
CL x Css ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#43 (reveal difficulty score)
A 53-year-old woman shows evidence of adrenal ...
Autoimmune adrenalitis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ








Question#1 (reveal difficulty score)
A 2-day-old full-term female newborn suddenly ...
Superior mesenteric ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#2 (reveal difficulty score)
Thirty minutes after taking 2 aspirin tablets ...
Acetaminophen ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#4 (reveal difficulty score)
A 24-year-old man who is comatose is admitted ...
25 mL/cm H2O ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#6 (reveal difficulty score)
A population of vegetarians is surveyed to ...
t-Test ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#8 (reveal difficulty score)
A 6-year-old boy who recently emigrated from ...
Vitamin E ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#10 (reveal difficulty score)
An 81-year-old man comes to the physician for ...
Atherosclerosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#11 (reveal difficulty score)
A 26-year-old woman comes to the physician 5 ...
Sertraline ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ






Question#17 (reveal difficulty score)
A 62-year-old man with dyslipidemia is ...
Gemfibrozil ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#18 (reveal difficulty score)
A 10-year-old girl has a slightly painful ...
Granuloma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ








Question#26 (reveal difficulty score)
A 60-year-old woman comes to the physician ...
Meningioma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#28 (reveal difficulty score)
A 48-year-old man comes to the emergency ...
Splenic vein ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#30 (reveal difficulty score)
A 27-year-old man who is a construction ...
Splenic flexure ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#31 (reveal difficulty score)
A 65-year-old man comes to the emergency ...
Crackles ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#33 (reveal difficulty score)
A 38-year-old single woman with a history of ...
Displacement ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#34 (reveal difficulty score)
A 17-year-old boy comes to the physician ...
B lymphocyte ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#36 (reveal difficulty score)
A 38-year-old man is admitted to the hospital ...
Acute-phase response ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#37 (reveal difficulty score)
A 53-year-old woman with a long history of ...
Tubular atrophy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#39 (reveal difficulty score)
A 5-year-old boy is brought to the physician ...
Retinal cells ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#41 (reveal difficulty score)
A 65-year-old woman with a 20-year history of ...
L-3 to 4 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#45 (reveal difficulty score)
An 1814-g (4-lb) male newborn is delivered in ...
Endodermal cells ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

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





Recent comments ...

... โˆ—sacredazn made a comment (nbme22)
 +70  submitted by sacredazn(101)

The concept is a convoluted way of asking if you knew how VDJ recombination works, which is that it is actually an example of altering the DNA of the B/T lymphocyte.

Southern blot technique: So when they use a probe against some region, and outputting a size of 1.5 kb or 6 kb, this is telling you the size of the DNA fragment in each cell (doesnโ€™t matter if they say J probe or constant region probe, theyโ€™re just saying theyโ€™re targeting some nucleotide sequence found in the Ig locus/TCR beta chain locus respectively for B/T cells).

I think the confusing part could be wondering how you know whether youโ€™re partly through rearrangement (answer choices B thru D) or if it hasnโ€™t occurred at all yet (correct answer). Here, the concept is that B cells undergo V(D)J rearrangement in the bone marrow, while T cells do it in the thymus, and it all happens at once. So a plasma cell in the blood like in Multiple Myeloma would have fully undergone recombination, while a T cell in the blood could either be fully educated (and have finished VDJ recombination) or immature (hasnโ€™t started VDJ).

Since the T cell gene was 6 kb and definitely bigger than the 1.5 kb gene, the T cell hasnโ€™t undergone recombination yet.

trichotillomaniac  very nice explanation! +29
nwinkelmann  This was awesome! Made so much sense and hopefully I will be able to think that critically about questions in the future (because I NEVER would have come up with this on my own, hah). +5
eacv  OMG! THANK YOU. I DIDNT KNOW ANYTHING about this!! Hope this is not testesd on real examen :p +5
ajss  wow! this explanation was awesome! thanks! +
mrglass  Also the T-cell V-D-J segments are not the same as the B-cell V-D-J segments. Therefore a B-cell J segment southern blot would look for whether the B-cell site VDJ segment in a T-cell, which would always non-rearranged. +6
peridot  This explanation is amazing! However, to fully understand another step of what the question is getting at, please take a look at @highyieldboardswards's and/or @mrglass' explanation as well - a very important addition!! +1
skonys  My logic was wrong but my answer correct. I am suffering from success. +
fhegedus  wow! this is amazing! thank you! +
... โˆ—seagull made a comment (nbme22)
 +67  submitted by seagull(1923)

Did anyone need to read that last sentence like 50 times because the author refuses to use better grammar. Just frustrating.

link981  Author rationale: "What is grammar?" +6
qfever  Did anyone read like 50 times and still get it wrong? (LOL, me) +22
drbravojose  Actually never understand what the author saying at any time. LOL +3
alimd  Such a shitty question. Do we really have such questions on the real exam? In my opinion they just throw junk question to those assesments +1
nootnootpenguinn  Oh my goodness- thank you! I was so mad at whoever wrote this shitty question! (Got it wrong lol) +
xmen  THEY GIVE SOMETIME WEIRD QUESTIONS DURING THE REAL EXAM !!! AND IT'S EXPERIMENTAL +
... โˆ—seagull made a comment (nbme22)
 +51  submitted by seagull(1923)

Which of the following reasons is why this question is bull?

1) Using the word "cyclic" instead of tricyclic for clarity

2) Knowing all of epidemiology of all drugs

3) having to reason out that anticholinergic effects are probably the worst over alpha1 or H1 effects to no certainty.

4) The crippling depression of studying for days-to-weeks on end to probably do average on the test.

nlkrueger  yo, re-fucking-tweet +26
aesalmon  I agree, I picked H1 because such a common complaint for those on TCAs is Sedation, I figure it might be so commonly seen as to be the "most common" reason for noncompliance. I suppose the "hot as a hare...etc" effects would be more severe/annoying, but I didn't think they were more common. +4
fcambridge  I just like to pretend that there's a reason this question is now in an NBME and no longer being used for the test. Hopefully they realized the idiocy of this question like we all do +1
link981  Since it said cyclic, I thought of using, discontinuing, then using again. These people who write these questions need take some English writing courses so they can write with CLARITY. Cyclic is not the same as Tricyclic. +5
waterloo  Incredibly awful question. one thought I did have when deciding between anticholinergic and antihistaminic - nortriptyline and desipramine are secondary amines that have less anti-cholinergic effects (from Sketchy Pharm) so maybe that's what they were getting at? That someone went out and made a new TCA drug that would have less anticholinergic effects. +
victor_abdullatif  This isn't testing drug epidemiology; it's actually asking "which of these side effects are caused by TCAs and would be the worst to experience?" +
tekkenman101  "worst to experience" is incredibly subjective lmao. +1
... โˆ—liverdietrying made a comment (nbme22)
 +36  submitted by liverdietrying(111)

This one was a little tricky. For this one the key is the low radioiodine uptake. This patient has high T4 and low TSH which makes sense in a hyperthyroid patient, perhaps your first thought is that this patient has Graveโ€™s disease. However, in Graveโ€™s your thyroid is being stimulated to make more thyroid hormone from scratch and as such would have an increased radioiodine uptake because the thyroid is bringing in the required (now radiolabeled) iodine. This is why it is not Graves (โ€œrelease of thyroid hormone from a thyroid stimulated by antibodiesโ€).

So if its not Graveโ€™s what could it be? For this youโ€™d have to know that Hashimotoโ€™s Thyroiditis (also known as Chronic Lymphocytic Thyroiditis and is often referred to as such on board exams to throw you off) has three phases - first they are hyperthyroid, then euthyroid, then the classic hypothyroid that you would expect with low T4 and high TSH. This was the key to this question. The reason for this is that antithyroid peroxidase antibodies in Hashimotoโ€™s cause the thyroid to release all of its stored thyroid hormone making the patient hyperthyroid for a short period of time. After this massive release of thyroid hormone, the antibodies make them unable to make new TH and therefore they become euthyroid for a short period and then hypothyroid which you would expect! Since they canโ€™t make new TH, the thyroid will not take up the radioiodine and therefore there will be low radioiodine uptake. Hence, โ€œrelease of stored thyroid hormone from a thyroid gland infiltrated by lymphocytes.โ€ aka โ€œLymphocytic (hashimotos) thyroiditisโ€.

I think โ€œrelease of thyroid hormone from a lymphomatous thyroid glandโ€ is referring to some kind of thyroid cancer in which case you would expect them to be describing a nodule on radioiodine uptake.

โ€‹Summary video here and also a great site in general: https://onlinemeded.org/spa/endocrine/thyroid/acquire

aesalmon  pg 338 of FA lists it under hypothyroidism but it does present as transient hyperthyroidism first +9
hyperfukus  yep that was the key! Goiter is "HOT" but the remaining answer choices were still kind of bleh D was distracting the hell out of me i spent so long to convince myself to pick C and move on +3
hello  Pasting nwinkelmann's comment as an addition: Choice "D" is wrong b/c "lymphomatous thyroid gland" = primary thyroid lymphoma (typically NHL, which is very rare) or Hashimoto's thyroid progression. Hashimoto's thyroiditis = lymphocytic infiltrate with germinal B cells and Hurthle cells, which upon continued stimulation, can lead to mutation/malignant transformation to B cell lymphoma. Both of these present with hypothyroidism with low T4 and high TSH (opposite of this patient). +1
taediggity  I absolutely love your @liverdietrying, however the pathogenesis of postpartum thyroiditis is similar to Hashimoto's, so I think this person has postpartum thyroiditis and your explanation of transient thyrotoxicosis is spot on, which would also occur in postpartum thyroiditis +16
pg32  I agree with @taediggity. Also note that women eventually recover from postpartum thyroiditis and typically become euthyroid again, which doesn't happen with Hashimoto's. +
vulcania  In FA (2019 p. 338) it says that thyroid is usually normal size in postpartum thyroiditis, but the patient in this question had a thyroid "twice the normal size." I guess at the end of the day it doesn't matter which diagnosis is right for this question cause they both seem to lead to the same correct answer :) +2


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