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NBME 23 Answers

nbme23/Block 2/Question#15 (88.5 difficulty score)
A child with septicemia has an antibiotic ...

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submitted by wired-in(67),
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ietnMennaca deos omlaurf si s(sC Γ— Cl Γ— )aut Γ· F

erhew sCs si tdsytee-aast aetrgt maalps ccn.o fo ugd,r lC si aclce,rane tau is eodsag eivtalnr pa;&m F si oiabvbtiliaai.yl

herNeit oageds rlievtan rno bilitailvoyabai si ,vigne so ginnorig tohes pm&;a pgglgiun ni the nermsbu r(alecuf ot ntveorc siunt ot )/gmdykga/:

2(1= gmu/L Γ— 1 /0gm010 )gu Γ— .9(00 /hgL/rk Γ— 0001 m1L/ L Γ— 24 h/1r y)da
= 522.9 //kgymgda

hihw..c. 'tnsi ayn fo hte wsnare hosccei d.ltesi heyT tsmu ehav duoedrn 00.9 rgh/Lk/ to 10. kh/L,r/g nda ingod so esivg elxtcya 8.28 gygkamd// cico(he )C

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +76  
hyoid  ^^^^^ +11  
seagull math never worked either. I also just chose the closest number. also, screw this question author for doing that. +9  
praderwilli  Big mad +9  
ht3  this is why you never waste 7 minutes on a question.... because of shit like this +9  
yotsubato  Why the FUCK did they not just give us a clearance of 0.1 if they're going to fuckin round it anyways... +18  
bigjimbo  JOKES +1  
cr  in ur maths, why did u put 24h/1day and not 1day/24h? if the given Cl was 0.09L/hr/kg. I know it just is a math question, but iΒ΄d appreciate if someone could explain it. +1  
d_holles  LMAO games NBME plays +2  
hyperfukus  magic math!!!!! how TF r we supposed to know when they round and when they don't like wtf im so pissed someone please tell me step isn't like this...with such precise decimal answers and a calculator fxn you would assume they wanted an actual answer! +1  
jean_young2019  OMG, I've got the 25.92 mg/kg/day, which isn't any of the answer choices listed. So I chose the D 51.8, because 51.8 is double of 25.9......I thought I must have make a mistake during the calculation ...... +6  
atbangura  They purposely did that so if you made a mistake with your conversion like I did, you might end up with 2.5 which was one of the answer choices. SMH +5  
titanesxvi  I did well, but I thought that my mistake was something to do with the conversion and end up choosing 2.5 because it is similar to 25.92 +3  
makinallkindzofgainz  The fact that we pay these people 60 dollars a pop for poorly formatted and written exams boggles my mind, and yet here I am, about to buy Form 24 +20  
qball  Me after plugging in the right numbers and not rounding down : +1  
frustratedllama  Not only do you feel like you're doing sth wrong but then that feeling stays for other questions. sucks so baad +  
fexx  'here.. take 50mg of vyvanse.. I just rounded it up from 30.. dw you'll be fine' (totally doing this with my patients 8-)) +1  
cbreland  I was so close to picking 2.5 because I thought I did a conversion error. 5 minutes later and still didn't feel comfortable picking 28.8😑 +  
yesa  12ug/ml = 12mg/L; 12mg/L x .1L/hr/kg x 24hr/day = 28.8. No need to multiple numerators and denominators by 1000s +  

submitted by hungrybox(1108),
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nugkcFi BMNE tset wtrrsei alom

Me: t".i..Wa tn'si eht esrwan 59.2? owH meoc I dton' see ti "re.he

NM:BE "Oh eyah, ew doundre .i"t

eM: o"T ?30 I tond' ese ahtt ,ehre"hi.

EBMN: N"o, ot ."828

tyrionwill  When I got 25.9 and found nothing exactly matched, I guessed that the maintenance dose might be a bit more due to the bioavailability. So this antibiotic probably was not an I.V. formula, but an oral one, with a roughly 90% BA. +2  
eradionova  Well then it could have been equally likely that it had a 50% BA and the answer would be 51.8 exactly. I almost considered picking that but in the end stuck with the one that was closest to my answer lol +2  

submitted by paperbackwriter(123),
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acn we all regea isth aws rfa oot uhcm ahmt nad tuin onv,enisrco YHW HET UTNI NOE!C!NIO?SSVR EW LLA YELACLR ADSEPS CEHM 011

submitted by anechakfspb(53),

In the question they also don't say whether the antibiotic is administered IV or orally. For an IV dose, F = 100%. For an oral dose, F is typically <100% (FA 2019 p. 233). Based on this, IV maintenance dose would be 25.92 mg/kg/day. However, it is possible that the antibiotic is being given orally and F is closer to 90% (just an example). If this is true, the maintenance dose would be 25.92/0.90 = 28.8. This is obviously based on assumptions, but hopefully another way to explain why the answer is not exactly 25.92.

veryhungrycaterpillar  Oral antibiotics for septicemia? None of the Step 1 question writers are medical doctors, so this actually makes sense. +1  

submitted by hyperfukus(90),
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so hlsdou we tsuj sipk ees?th ucz rse'hte rpob 01 omre i cdueovl egontt ertiw nawitsg my lfei no hsti oen

faus305  Don't skip it but flag it, give yourself 1 minute and 30 seconds or less to figure it out and if you don't then move on and come back if you have time. Questions like these are what I like to call "time wasters." I got it wrong because I selected 2.5 assuming I made a conversion error when I arrived at 25.9 as my answer. I think the lesson to learn here is that 28 is closer to 25 than 2.5 and NBME are evil people that know I'm not gonna make a conversion error. If you do math in a question and you are SURE you did it write, select the answer closest to the answer your math got you. +  

submitted by isaacyo94(8),

Another weird thing with this question is that if you multiple the actual answer (25.9) by 2, it gives you exactly 51.8. I did that and almost chose D because of it.

submitted by diabetes(28),
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1g2m=mlLg/12M/ 2 1..000=198 k1/r/h0.m g8g2425.=92 k/yd/gamg t eh saerten wnnears si 82.8

submitted by docred123(7),
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yHe anc esoomne aelpes pixnale !htis I ma otn eusr ohw ot od the mhta, I pkee tgeting drtpepi pu.

mousie  Equation is Maintenance dose = (concentration at steady state) * (Clearance) if you convert all the units to what it wanted them in (mg/kg/day) you'll get 25.92 like weird-in said above I didn't think to round 0.09 to 0.1 of course so I guessed 2.5 assuming I must have done a conversion wrong and was off by a tenth .... BOO bad Q +4  
hyperfukus  OMG ME TOO!!!!! +