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NBME 23 Answers

nbme23/Block 2/Question#15 (78.5 difficulty score)
A child with septicemia has an antibiotic ...
28.8🔍
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 +25 
submitted by wired-in(67),
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enatnnaMcie dose furomla si sCs( × lC × at)u ÷ F

erhew Css si -aadyetsstet tgaret mlpaas n.coc of r,ugd Cl si nercaeca,l tua si oesdag rnaetvli &am;p F si bi.ovilbtiaiaaly

hNteeir edsago vrintael rno iailbbailayitov si gvine, os gngrioin soeht &m;ap gnluigpg ni eht msubrne uc(lefar to netcvro tisun to gyk/da:m)g/

=(21 gmL/u × 1 0/mg001 g)u × 09.(0 /khL/rg × 0100 Lm1/ L × 24 h1r/ y)da
= 2259. y/m/kadgg

.wih..hc 'itsn ayn fo eth reswna csoechi lietds. ehTy sumt aveh nrddeuo .900 L/rkh/g ot .01 kLgrh/,/ and igndo os vsieg axcyetl 8.28 myg/ka/gd ohccei( )C

lispectedwumbologist  That's so infuriating I stared at this question for 20 minutes thinking I did something wrong +69  
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 +8  
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 i´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 +3  
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 +2  
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 +15  
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😡 +  



 +8 
submitted by hungrybox(961),

Fucking NBME test writers lmao

Me: "Wait... isn't the answer 25.9? How come I don't see it here."

NBME: "Oh yeah, we rounded it."

Me: "To 30? I don't see that here, either..."

NBME: "No, to 28.8"

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  



 +2 
submitted by paperbackwriter(101),

can we all agree this was far too much math and unit conversion, WHY THE UNIT CONVERSIONS!?! WE ALL CLEARLY PASSED CHEM 101




 +1 
submitted by hyperfukus(74),
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os dolhsu ew utjs ipsk shete? ucz e'sreth bopr 01 ermo i euvdolc tneotg wietr tgawisn my eifl no sith eno

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. +  



 +1 
submitted by anechakfspb(27),

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.




 +0 
submitted by isaacyo94(5),

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(25),
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l//L1M22gg=1mm 12 =00.8091. g/gh /0.18rkm5.2294=2 /kgmay/dg eth esenatr nnaesrw is 28.8




 +0 
submitted by docred123(6),
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eHy nac eoneosm lsepae alpenxi this! I am otn sure ohw to do eth tahm, I eepk gnetigt pdetpri 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!!!!! +