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NBME 22 Answers

Block 1/Question#1
A 66-year-old man develops worsening shortness of breath and ...
Dilution of serum sodium due to ADH (vasopressin) secretion

Block 1/Question#2
A 28-year-old man has recurrent pancreatitis associated with ...
Decreasing VLDL

Block 1/Question#3
Parenterally administered cholera vaccines consisting of ...
Inability of the vaccine to elicit secretory antibody at the epithelial surface

Block 1/Question#4
A 48-year-old man begins furosemide therapy for pedal edema ...
Decreases the luminal permeability to Na+ in the collecting duct

Block 1/Question#5
A 10-month-old girl is brought to the emergency department ...
Naloxone

Block 1/Question#6
A 2-month-old boy is brought to the physician because of a ...
Human papillomavirus

Block 1/Question#7
Two patients, a 54-year-old man (Patient X) and a 76-year-old ...
Loading dose

Block 1/Question#8
A 16-year-old girl has pain and tingling in her left hand ...
Cervical rib

Block 1/Question#9
A 54-year-old man has an aneurysm in the distal portion of ...
2.4

Block 1/Question#10
A 25-year-old woman is admitted to the hospital because of ...
Streptococcus pneumoniae

Block 1/Question#11
A 6-month-old boy has recently been diagnosed with ...
Sphingomyelin degradation

Block 1/Question#12
During the first week of life, a male newborn has vomiting, ...
21-Hydroxylase

Block 1/Question#13
A 13-year-old girl is brought to the physician by her mother ...
Ask the mother to leave the room before asking the patient any questions

Block 1/Question#14
A 57-year-old woman comes to the physician because of ...
Trigeminal neuralgia

Block 1/Question#15
A 35-year-old woman has weakness and fever. When she was 25 ...
Acute myelocytic leukemia

Block 1/Question#16
An Rh-negative woman, gravida 3, para 2, has had an ...
O, Rh-negative

Block 1/Question#17
A 27-year-old man is brought to the emergency department ...
Eversion

Block 1/Question#18
A 13-year-old boy is brought to the physician for a ...
Reassurance

Block 1/Question#19
An 11-year-old boy has had pain in his right mid-thigh for 2 ...
Ewing sarcoma

Block 1/Question#20
A 49-year-old man comes to the physician because of ...
Avascular necrosis

Block 1/Question#21
A 30-year-old man comes to the physician because of a 2-day ...
Polycystin

Block 1/Question#22
A previously healthy 6-year-old boy is brought to the ...
Does anyone else in the family have an itchy rash like this?

Block 1/Question#23
A patient in the early stages of hemorrhagic shock is most ...
A weak pulse due to decreased stroke volume

Block 1/Question#24
A 48-year-old man with renal artery stenosis undergoes stent ...
Testicular artery

Block 1/Question#25
During an experiment, a 22-year-old man receives an infusion ...
Arteriolar resistance: decreased;
Capillary hydrostatic pressure: increased;
Capillary filtration rate: increased


Block 1/Question#26
A 42-year-old man comes to the physician because of a 1-month ...
Hydrochlorothiazide

Block 1/Question#27
During a clinical study, 15 patients with renal allografts ...
Azathioprine

Block 1/Question#28
A 48-year-old man comes to the physician because of fatigue, ...
Transferrin saturation and serum ferritin measurements

Block 1/Question#29
A 28-year-old man comes to the emergency department because ...
Jejunum

Block 1/Question#30
A 42-year-old woman is brought to the emergency department by ...
Temporal lobe

Block 1/Question#31
A 60-year-old woman comes to the physician because of a ...
Lung cancer

Block 1/Question#32
A 17-year-old boy is brought to the emergency department 45 ...
Hypokalemia

Block 1/Question#33
A 32-year-old woman begins to hyperventilate and then ...
Cerebral blood flow

Block 1/Question#34
A 15-year-old girl is brought to the physician by her mother ...
First-degree burn

Block 1/Question#35
A 35-year-old man is brought to the hospital after a diving ...
Alteration of the thermostatic set point

Block 1/Question#36
A 67-year-old woman comes to the physician because of a ...
Idiopathic pulmonary fibrosis

Block 1/Question#37
A 28-year-old woman is brought to the physician because of a ...
Area labeled ‘C’ (Abducens nucleus, right)

Block 1/Question#38
A newborn born at 26 weeks' gestation has respiratory ...
Dipalmitoyl lecithin

Block 1/Question#39
A 23-year-old woman develops multiple red, papulovesicular ...
Processing of antigen by Langerhans cells, leading to activation of CD4+ T cells

Block 1/Question#40
A 45-year-old man with chronic pancreatitis caused by alcohol ...
Pancrelipase

Block 1/Question#41
A 21-year-old man is brought to the emergency department 1 ...
Gender and body habitus

Block 1/Question#42
An 18-year-old woman develops sepsis after an abortion. ...
Decreased plasma fibrinogen concentration

Block 1/Question#43
A 13-year-old girl is brought to the emergency department 15 ...
C1 inhibitor

Block 1/Question#44
A 52-year-old man with a history of alcoholic cirrhosis is ...
Superior rectal

Block 1/Question#45
A 16-year-old girl is brought to the physician because of ...
Diuretics

Block 1/Question#46
A 12-year-old girl is referred to the emergency department by ...
Conversion disorder

Block 1/Question#47
A 25-year-old woman comes to the physician because of easy ...
Immune thrombocytopenic purpura

Block 1/Question#48
A 1-year-old boy is found to have an impairment of the ...
Staphylococcus aureus

Block 1/Question#49
A 17-year-old primigravid woman at 16 weeks' gestation has a ...
Azithromycin

Block 1/Question#50
A 9-year-old boy is brought to the physician by his mother ...
Protein structure

Block 2/Question#1
A 29-year-old woman is brought to the emergency department 1 ...
Avulsion of hepatic veins from the inferior vena cava

Block 2/Question#2
A 65-year-old man starts using topical fluorouracil for ...
Thymidylate synthase

Block 2/Question#3
A previously healthy 28-year-old man comes to the physician's ...
Nephrolithiasis

Block 2/Question#4
A previously healthy 60-year-old woman is admitted to the ...
Increased central venous pressure

Block 2/Question#5
A 74-year-old man with emphysema and lung cancer is brought ...
Negative nitrogen balance

Block 2/Question#6
A 52-year-old man is brought to the emergency department 1 ...
4 Months

Block 2/Question#7
A 66-year-old man comes to the physician because of a 2-month ...
Libido: decreased;
Nocturnal erections: normal


Block 2/Question#8
A 73-year-old man has difficulty urinating and frequent ...
Area labeled ‘E’

Block 2/Question#9
A 26-year-old woman develops hypotension and hemoglobinuria ...
Antibody, complement C5-9

Block 2/Question#10
A 56-year-old man with a palpable hard nodule on the prostate ...
Pelvic parasympathetic nerves

Block 2/Question#11
A 52-year-old man comes to the physician because a lump in ...
Sensation from the anterior surface of the scrotum

Block 2/Question#12
A 42-year-old woman with frequent heartburn has relief of ...
cAMP

Block 2/Question#13
A 5-year-old boy who lives on a farm has had diarrhea, ...
Yersinia enterocolitica

Block 2/Question#14
A previously healthy 12-year-old boy is brought to the ...
Glucose and sodium

Block 2/Question#15
A 62-year-old woman comes to the physician 3 days after ...
Carcinoma of the breast

Block 2/Question#16
A 60-year-old man is brought to the emergency department ...
Prostate adenocarcinoma

Block 2/Question#17
Ten healthy human subjects are given a new oral drug and ...
Phase 1

Block 2/Question#18
A 32-year-old man comes to the physician because of a 2-week ...
Reverse transcriptase

Block 2/Question#19
A 50-year-old man comes to the physician 3 days after his ...
Calcium

Block 2/Question#20
A 26-year-old nulligravid woman comes to the physician ...
Hypothalamus

Block 2/Question#21
A newborn has cyanosis, tachypnea, and retractions of the ...
Respiratory acidosis and metabolic acidosis

Block 2/Question#22
A 35-year-old man comes to the physician because of a 3-year ...
Adenylyl cyclase

Block 2/Question#23
A 32-year-old woman comes to the physician because of a 1-day ...
Reduviid bug

Block 2/Question#24
A 72-year-old man is given ketorolac for pain control after ...
Acute renal failure

Block 2/Question#25
A 37-year-old woman undergoes excision of a 1-cm, painless, ...
Angiogenesis

Block 2/Question#26
A randomized controlled trial is conducted to assess the ...
(194/2371) – (123/2365)

Block 2/Question#27
A 50-year-old man who has smoked 2 packs of cigarettes a day ...
Increased blood HCO3−

Block 2/Question#28
A 65-year-old man comes to the physician for a follow-up ...
Ulnar and tibial

Block 2/Question#29
A 79-year-old man is brought to the emergency department by ...
Insertion of transvenous pacemaker

Block 2/Question#30
A 40-year-old woman comes to the physician because of a ...
Multifactorial

Block 2/Question#31
An unimmunized 1-year-old boy is admitted to the hospital ...
Phase variation

Block 2/Question#32
A 54-year-old man who works in a delicatessen comes to the ...
Schwann cells

Block 2/Question#33
A 29-year-old woman comes to the physician because of a ...
Thyroid-stimulating hormone: decreased;
Free thyroxine: decreased;
Free triiodothyronine: increased


Block 2/Question#34
A 30-year-old man and a 24-year-old woman (indicated by the ...
1 in 600

Block 2/Question#35
A 45-year-old man with Li-Fraumeni syndrome agrees to ...
Decreased binding of RNA polymerase

Block 2/Question#36
Which of the following drug effects is the most common reason ...
Anticholinergic

Block 2/Question#37
A 63-year-old man has had progressive stiffness over the past ...
Area labeled ‘D’

Block 2/Question#38
Following a stroke, a patient is hoarse and cannot detect ...
Lateral medulla

Block 2/Question#39
A 22-year-old woman comes to the office because of a 3-day ...
Cardiomyopathy

Block 2/Question#40
A previously healthy 7-year-old girl is brought to the ...
Serum potassium concentration

Block 2/Question#41
A 12-year-old boy is swimming in a mountain stream. He is ...
Central blood volume: increased;
Serum ADH (vasopressin): decreased;
Serum atrial natriuretic peptide: increased


Block 2/Question#42
A 75-year-old woman has taken 12 over-the-counter ...
Plasma renin activity

Block 2/Question#43
A 20-year-old man comes to the physician because of tingling ...
Area labeled ‘C’

Block 2/Question#44
A 3-day-old full-term male newborn is brought to the ...
Hepatic UDP-glucuronosyltransferase activity

Block 2/Question#45
An 86-year-old man who lives in a skilled nursing care ...
Dextromethorphan

Block 2/Question#46
A 62-year-old man is being evaluated for rectal bleeding. An ...
Greater mucosal surface area

Block 2/Question#47
A 22-year-old woman who is at 16 weeks' gestation has ...
Down syndrome

Block 2/Question#48
Clostridium perfringens-α toxin affects cells and facilitates ...
Splitting lecithin to phosphorylcholine and diglyceride

Block 2/Question#49
A physician is unable to communicate "bad news" to a patient ...
Countertransference

Block 2/Question#50
An 18-month-old boy is admitted to the hospital because of ...
Tuberous sclerosis complex

Block 3/Question#1
A 35-year-old man comes to the physician because of a 6-week ...
C7 nerve root

Block 3/Question#2
A 30-year-old man is brought to the emergency department 30 ...
Increased serum angiotensin II concentration

Block 3/Question#3
An obese 45-year-old woman with type 2 diabetes mellitus, ...
Diarrhea

Block 3/Question#4
A 29-year-old woman has an inflammatory disease involving her ...
Immune complex-mediated cytotoxicity

Block 3/Question#5
A 72-year-old man with multiple myeloma agrees to participate ...
Unrearranged immunoglobulin gene

Block 3/Question#6
A 50-year-old man is admitted to the hospital because of ...
Intracellular [Na+]: increased;
Intracellular [K+]: decreased;
Intracellular [Ca2+]: increased


Block 3/Question#7
A 50-year-old man who is a college professor has had an ...
It must be difficult for you to accept this diagnosis when you feel healthy.

Block 3/Question#8
A 38-year-old man who lives at sea level flies to a mountain ...
pH: increased;
HCO3-: increased;
Volume: increased


Block 3/Question#9
Microelectrode injection of antibodies to α-actinin results ...
Area labeled ‘C’

Block 3/Question#10
A 50-year-old man comes to the physician for follow-up ...
Yes; the patient may wish to consider the money's influence on the physician's recommendation

Block 3/Question#11
A 38-year-old man with Down syndrome is brought to the ...
Contact adult protective services

Block 3/Question#12
An 82-year-old woman has been bedridden since surgical repair ...
Carboxylation of precursor proteins

Block 3/Question#13
A previously healthy 26-year-old woman comes to the physician ...
Acute retroviral infection

Block 3/Question#14
A 57-year-old woman comes to the physician 2 weeks after ...
Intercostal

Block 3/Question#15
An 18-year-old man comes to the physician 10 days after ...
C8

Block 3/Question#16
A 27-year-old woman comes to the physician because of ...
Antiphospholipid antibodies

Block 3/Question#17
A 50-year-old man with chronic gastritis is diagnosed with a ...
Helicobacter pylori

Block 3/Question#18
An 85-year-old woman is diagnosed with a fracture of the ...
Morphine is metabolized to active metabolites that accumulate

Block 3/Question#19
A 42-year-old man comes to the physician because of numbness ...
Sensory neuropathy

Block 3/Question#20
A 43-year-old man is brought to the emergency department ...
Fibularis (peroneus) brevis

Block 3/Question#21
A screening test for cancer is developed and applied to 500 ...
Data point labeled ‘A’

Block 3/Question#22
A study is conducted to assess the prevalence of hypertension ...
Chi-square test

Block 3/Question#23
A 45-year-old woman comes to the physician for a follow-up ...
25%

Block 3/Question#24
An 84-year-old woman comes to the physician because of a ...
Downregulation of E-cadherin

Block 3/Question#25
A 3-month-old girl is brought to the physician by her mother ...
Motor: normal;
Social: delayed;
Verbal and cognitive: delayed


Block 3/Question#26
A study is conducted to assess the extent of cardiac valvular ...
Type I error: No change;
Type II error: decreased


Block 3/Question#27
A 45-year-old man with poorly controlled type 2 diabetes ...
Enterococcus faecalis

Block 3/Question#28
A 12-year-old girl who recently immigrated to the USA from ...
Praziquantel

Block 3/Question#29
A 45-year-old man with end-stage renal failure is brought to ...
Bicarbonate

Block 3/Question#30
Which of the following is required for the synthesis of ...
Glutamine

Block 3/Question#31
A 35-year-old man is admitted to the hospital because he has ...
Absorption of nitrogenous products from the gastrointestinal tract

Block 3/Question#32
A 25-year-old woman comes to the physician because of a ...
Fasting insulin: increased;
Testosterone: increased;
Luteinizing hormone: increased


Block 3/Question#33
A 22-year-old man comes to the physician because of ...
47,XXY

Block 3/Question#34
The risk for hemorrhagic stroke from drug X is investigated ...
Case-control study

Block 3/Question#35
A 4-year-old boy is brought to the physician by his parents ...
Interstitial inflammation

Block 3/Question#36
A 62-year-old man comes to the physician's office for ...
Alternative treatments

Block 3/Question#37
A 35-year-old man with bronchial asthma starts taking ...
Increase in cAMP

Block 3/Question#38
A 73-year-old man comes to the physician with his wife ...
Blood pressure

Block 3/Question#39
A 52-year-old man with stable angina pectoris begins ...
Headache

Block 3/Question#40
A 49-year-old man has had the gradual onset of numbness and ...
Essential thrombocythemia

Block 3/Question#41
A 56-year-old man develops brief episodes of ventricular ...
CL x Css

Block 3/Question#42
A 62-year-old man comes to the physician for a follow-up ...
Inorganic phosphorus: increased;
Parathyroid hormone: increased;
Calcitriol: decreased


Block 3/Question#43
A 53-year-old woman shows evidence of adrenal failure. On CT ...
Autoimmune adrenalitis

Block 3/Question#44
A 35-year-old man comes to the physician because of an itchy ...
Prescribe permethrin for the patient and his family

Block 3/Question#45
A 28-year-old man who is seropositive for HIV has numerous ...
Slit-like vascular spaces with plump spindle-shaped stromal cells

Block 3/Question#46
A 54-year-old woman with hypertension and bilateral renal ...
Vasodilating prostaglandins at the afferent arteriole

Block 3/Question#47
A 10-year-old boy receives a renal transplant from a living, ...
Lymphocytes infiltrating tubular epithelium

Block 3/Question#48
A 2-year-old boy is brought to the physician because of fever ...
Bruton agammaglobulinemia

Block 3/Question#49
A 42-year-old man is brought to the emergency department ...
Dopaminergic neurons in the substantia nigra

Block 3/Question#50
A 56-year-old woman is brought to the emergency department by ...
Herpes encephalitis

Block 4/Question#1
A 2-day-old full-term female newborn suddenly develops ...
Superior mesenteric

Block 4/Question#2
Thirty minutes after taking 2 aspirin tablets for a tension ...
Acetaminophen

Block 4/Question#3
A 60-year-old man comes to the physician because of ...
Alveolar macrophage

Block 4/Question#4
A 24-year-old man who is comatose is admitted to the hospital ...
25 mL/cm H2O

Block 4/Question#5
A new virus has been isolated that causes encephalitis. The ...
Single-stranded positive-sense

Block 4/Question#6
A population of vegetarians is surveyed to investigate the ...
t-Test

Block 4/Question#7
A 27-year-old man comes to the physician for a routine ...
Ask the patient to identify the pros and cons of smoking cessation

Block 4/Question#8
A 6-year-old boy who recently emigrated from Russia is ...
Vitamin E

Block 4/Question#9
A 5-year-old boy is brought to the physician because of a ...
Interruption of erythrocyte production

Block 4/Question#10
An 81-year-old man comes to the physician for ongoing ...
Atherosclerosis

Block 4/Question#11
A 26-year-old woman comes to the physician 5 weeks after the ...
Sertraline

Block 4/Question#12
A 73-year-old woman dies 7 years after the onset of ...
Hydrocephalus ex vacuo

Block 4/Question#13
A 36-year-old woman comes to the physician because of a ...
Cytosol with translocation into the nucleus

Block 4/Question#14
In patients with adenosine deaminase deficiency, there is a ...
Ribonucleotide reductase

Block 4/Question#15
A 24-year-old woman, gravida 1, para 1, comes to the ...
Release of stored thyroid hormone from a thyroid gland infiltrated by lymphocytes

Block 4/Question#16
A 4-month-old boy is brought to the office by his parents ...
Maxillary and medial nasal prominences

Block 4/Question#17
A 62-year-old man with dyslipidemia is brought to the ...
Gemfibrozil

Block 4/Question#18
A 10-year-old girl has a slightly painful 2-mm subcutaneous ...
Granuloma

Block 4/Question#19
A 76-year-old man with a 1-month history of a pulsatile ...
Anomalous origins of multiple renal arteries to each kidney

Block 4/Question#20
During a study of symptomatic proximal deep venous ...
Open-label clinical trial

Block 4/Question#21
A previously healthy 45-year-old woman has had fever, ...
Thrombotic thrombocytopenic purpura

Block 4/Question#22
A 37-year-old man comes to the physician for a follow-up ...
Hyperplastic arteriolosclerosis

Block 4/Question#23
A 57-year-old woman comes to the office because of a 5-week ...
Autoimmune downregulation of Ca2+ channels of the presynaptic terminal

Block 4/Question#24
A 39-year-old woman with rheumatoid arthritis comes to the ...
Tumor necrosis factor-α

Block 4/Question#25
A healthy 25-year-old man eats a meal consisting of 60% ...
Fusion of an intracellular vesicle with the plasma membrane

Block 4/Question#26
A 60-year-old woman comes to the physician because of a ...
Meningioma

Block 4/Question#27
A 78-year-old man comes to the physician because of a 3-month ...
Metastatic carcinoma

Block 4/Question#28
A 48-year-old man comes to the emergency department because ...
Splenic vein

Block 4/Question#29
A 45-year-old man who is HIV positive comes to the physician ...
Disruption of the pathogen cell membrane

Block 4/Question#30
A 27-year-old man who is a construction worker is brought to ...
Splenic flexure

Block 4/Question#31
A 65-year-old man comes to the emergency department because ...
Crackles

Block 4/Question#32
A case-control study is conducted to assess the relationship ...
Cannot be determined from the data given

Block 4/Question#33
A 38-year-old single woman with a history of chronic ...
Displacement

Block 4/Question#34
A 17-year-old boy comes to the physician because of a 1-week ...
B lymphocyte

Block 4/Question#35
Nicotinic acid acts at which of the following labeled sites ...
Pathway labeled ‘C’

Block 4/Question#36
A 38-year-old man is admitted to the hospital after ...
Acute-phase response

Block 4/Question#37
A 53-year-old woman with a long history of fibromuscular ...
Tubular atrophy

Block 4/Question#38
Patients with mucolipidosis II (I-cell disease) lack the ...
Secreted from the cells

Block 4/Question#39
A 5-year-old boy is brought to the physician because of pain ...
Retinal cells

Block 4/Question#40
A 5-year-old boy with mental retardation is grossly obese and ...
Maternal origin of both chromosomes 15

Block 4/Question#41
A 65-year-old woman with a 20-year history of osteoarthritis ...
L-3 to 4

Block 4/Question#42
A 31-year-old man comes to the physician because of concerns ...
Dihydrotestosterone

Block 4/Question#43
A 44-year-old man comes to the physician because of fever and ...
Tricuspid insufficiency

Block 4/Question#44
A 10-year-old boy has bruised easily since swallowing some of ...
Prolonged prothrombin time

Block 4/Question#45
An 1814-g (4-lb) male newborn is delivered in the hospital at ...
Endodermal cells

Block 4/Question#46
A 39-year-old woman comes to the physician because of ...
Hemoglobin

Block 4/Question#47
A 56-year-old woman comes to the physician for a follow-up ...
Maintenance of basement membrane integrity

Block 4/Question#48
An 8-year-old boy is brought to the physician by his parents ...
Calorie consumption that exceeds energy expenditure

Block 4/Question#49
A 52-year-old man with metastatic oat cell carcinoma begins ...
Ensure that the patient receives enough medication to control his pain

Block 4/Question#50
A 31-year-old woman in the second trimester of pregnancy is ...
Hematopoietic stem cells

Recent comments ...

... sacredazn made a comment on nbme22/block3/q#5 (A 72-year-old man with multiple myeloma agrees to...)
 +17  upvote downvote
submitted by sacredazn(25)

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 (doesn’t matter if they say J probe or constant region probe, they’re just saying they’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 you’re partly through rearrangement (answer choices B thru D) or if it hasn’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 (hasn’t started VDJ).

Since the T cell gene was 6 kb and definitely bigger than the 1.5 kb gene, the T cell hasn’t undergone recombination yet.

trichotillomaniac  very nice explanation!
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).
eacv  OMG! THANK YOU. I DIDNT KNOW ANYTHING about this!! Hope this is not testesd on real examen :p
... seagull made a comment on nbme22/block2/q#35 (A 45-year-old man with Li-Fraumeni syndrome agrees...)
 +17  upvote downvote
submitted by seagull(422)

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?"
... seagull made a comment on nbme22/block2/q#36 (Which of the following drug effects is the most...)
 +16  upvote downvote
submitted by seagull(422)

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
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.
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
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.
... keycompany made a comment on nbme22/block2/q#5 (A 74-year-old man with emphysema and lung cancer is...)
 +15  upvote downvote
submitted by keycompany(115)

Nitrogen balance is a measurement of protein metabolism in the body. A negative nitrogen balance indicates muscle loss, as increased amounts of amino acids are being metabolized to produce energy. This increases the amount of nitrogen secreted from the body. Because the amount of nitrogen you are taking in is less than the amount of nitrogen you are secreting, you have a negative nitrogen balance.

This man is malnourished, edematous, cachetic, and has hypoalbuminemia. These clinical findings point to protein malnutrition (Kawashkior Disease), which causes edema due to decreased serum oncotic pressure. Low oncotic pressure in this case is due to protein loss, and hence a negative nitrogen balance.

drdoom  Nice!
dubywow  I knew your last sentence and suspected Kwashiorkor. It's just everything else I did not know. I have not heard or thought of muscle/protein changes in terms of "nitrogen balance" before... and that's why I got this wrong. Nice explanation!
... alwaysanonymous made a comment on nbme22/block4/q#4 (A 24-year-old man who is comatose is admitted to the...)
 +12  upvote downvote
submitted by alwaysanonymous(14)

His tidal volume was 500 mL. End-expiratory was +5 cm and end-inspiratory was +25. We were supposed to use the difference in airway pressure, and not the end-inspiratory pleural pressure (+20).

Compliance = ΔV/ΔP = 500 / 20 = 25 mL/cm H2O

some-zheimers  Great explanation. In general, also a great idea to pay attention to the units. I studied Physics in undergrad and have got one or two questions based purely on following the units, when the formula slips.
endochondral1  is that equation in FA?
redvelvet  yes @endochondral1, at page 651 in 2019FA
... keycompany made a comment on nbme22/block1/q#9 (A 54-year-old man has an aneurysm in the distal...)
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submitted by keycompany(115)

Flow Rate = Velocity x Cross-Sectional Area

2 cm^2 x 20 cm/sec x 60 sec/min x 1 L/1,000 cm^3 = 2.4 L/min

1,000 cm^3 = 1 L

seagull  Well, I missed this one. I don't even feel bad.
link981  @keycompany a small typo, 100 cm^3 = 1 L not 1000cm^3. 1000 mL^3= 1 L
hello  @keycompany how did you edit your original comment to fix your typo?
... mcl made a comment on nbme22/block2/q#37 (A 63-year-old man has had progressive stiffness over...)
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submitted by mcl(202)

This image is useful. Note that the stain used makes myelin appear dark.

Vignette is typical for Parkinson's disease. Area D is the substantia nigra.

oznefu  Oh nice! Thanks!
... bubbles made a comment on nbme22/block3/q#13 (A previously healthy 26-year-old woman comes to the...)
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submitted by bubbles(30)

For the peeps who got confused on this question bc of UWorld's weird question on HIV viral load:

acute HIV-1 infection: HIGH viral load, low Ab HIV-2 infection: LOW viral load, low Ab (bc standard HIV assays detect p24, which is not present on HIV-2)

Kinda annoyed I missed an easy immunology concept question :/

eacv  I feel you my friend! same stupid mistake over here -.-
step1soon  FA 2019 pg 176
... moloko270 made a comment on nbme22/block1/q#30 (A 42-year-old woman is brought to the emergency...)
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submitted by moloko270(30)

FA p.547 - burning rubber smell hallucination occurs as an aura for temporal lobe epilepsy

... keycompany made a comment on nbme22/block2/q#41 (A 12-year-old boy is swimming in a mountain stream....)
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submitted by keycompany(115)

Answer: Increased Central Blood Volume (CBV), Decreased ADH, Increased ANP.

The physiological response to hypothermia is vasoconstriction of peripheral vessels (i.e. the ones in your extremities) in an effort to keep your core body temperature normal, and thus your organs functioning properly. Peripheral Vasoconstriction will increase CBV. Increased CBV will cause an increase in preload, and thus cause an increase in ANP/BNP. ANP/BNP has inhibitory effects on the Renin-Angiotensin-Aldosterone System, resulting in decreased ADH.

... usmleuser007 made a comment on nbme22/block3/q#22 (A study is conducted to assess the prevalence of...)
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submitted by usmleuser007(112)

Just remember:

1) T-test (tea for two) = looks at the mean values of 2 groups

2) ANOVA (analysis of variance) ~ like t-test but = looks at mean values of 3 or more groups

3) Chi-square = looks at the (%) or proportions between 2 or more groups.

so, just look for how many groups being addressed and what values they are using (% or means)

... drdoom made a comment on nbme22/block2/q#34 (A 30-year-old man and a 24-year-old woman (indicated...)
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submitted by drdoom(190)

Calculations for dad. The probability of the father being a carrier is 2/3 since it is known that he doesn’t have the disease. Then the probability of him passing it on to his kid is 1/2, thus:

  • Probability of dad being carrier = 2/3
  • Probability of dad passing on disease allele = 1/2

Calculations for mom. With the Hardy-Weinberg Principle, you can figure out the probability of the mother being a carrier:

q = sqrt(1/40,000) = 1/200

So, 2pq = 2 * 1/200 * 199/200, which is approx 1/100.

For the child to get the allele from mom, two things need to happen: (1) mom must be a carrier [“heterozygote”] and (2) mom must pass the allele to child:

  • Probability of mom being carrier = 1/100
  • Probability of mom passing on disease allele = 1/2

Puting it all together. Now, combine all together:

= (probability of dad being carrier) * (probability of dad passing on disease allele) * (probability of mom being carrier) * (probability of mom passing on disease allele)

= 2/3 * 1/2 * 1/100 * 1/2
= 1 in 600

kernicterusthefrog  To quote Thorgy Thor, drag queen: "ew, Jesus, gross"
niboonsh  This question makes me want to vomit
drdoom  lol
... joha961 made a comment on nbme22/block4/q#33 (A 38-year-old single woman with a history of chronic...)
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submitted by joha961(13)

Like others have said, I think sublimation would have been better, but displacement from first aid says that it is, “redirection of emotions or impulses to a neutral person or object” so she’s kicking her family by kicking the bag.

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