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NBME 23 Answers

nbme23/Block 2/Question#15 (88.5 difficulty score)
A child with septicemia has an antibiotic ...
28.8πŸ”,πŸ“Ί
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 +25 
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  lol..my 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 : https://i.kym-cdn.com/entries/icons/original/000/028/539/DyqSKoaX4AATc2G.jpg +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 +  



 +9 
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 r.ee.t"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  



 +4 
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




 +2 
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  



 +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. +  



 +0 
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.




 +0 
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




 +0 
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!!!!! +