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Retired NBME 24 Answers

nbme24/Block 2/Question#12 (reveal difficulty score)
An 80-year-old man is admitted to the ...
20 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: biostats

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 +12  upvote downvote
submitted by skinnynomore(15)
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Theyโ€™re giving a lot of confusing extra information here, maybe to trip us up. They just want volume of distribution, simple as that.

Vd = [drug administered] รท [plasma drug concentration]

First convert it all to g/L because this is how the answer will be:

administered: 80 mg = 0.08 g plasma concentration: 4 ug/ml = 0.004 g/L

Thus,

Vd = 0.08 grams รท 0.004 g/L = 20 L

Clearance of drug is not a huge factor because the half life is so long that the drug is distributing before significant clearance occurs.

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gonyyong  I think the distribution half-life and elimination half-life was saying that by the time you checked, it had fully distributed (10 half-lifes) and had not been cleared yet (super long half-life) +18
soph  1000ug= 1mg and 1g=1000000ug so then 4ug/ml * 1g/ 1000000ug= 0.000004 g/ml 0.000004g/ml * 1000ml/L= 0.004 g/L 80mg*1g/1000mg= 0.08 g vd= 0.08g/ 0.04g/l =20L +6
tiredofstudying  Or, like a normal human, convert 4ug/mL into mg/L ... which is 4 mg/L. 80mg/4mg/L is 20L. +28
corgilobacter  I hate NBME... I thought these stupid conversions were over after undergrad. Nope. +2
yesa  You do 1000000000s of these a day if you do any type of labwork o.O You just get used to it eventually +



 +9  upvote downvote
submitted by โˆ—fahmed14(31)
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Vd = amount of drug in body / plasma drug concentration.

Amount of drug in body = 80mg

Plasma drug concentration = 4 micrograms/mL = 4mg/L

Vd = 80mg/(4mg/L) = 20L

Distribution half-life is 3 minutes so after 30 min we can assume the drug is maximally distributed. Elimination half-life is 24 hours so we can assume a neglible amount of drug lost

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 +2  upvote downvote
submitted by โˆ—lm4(23)
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you could also have used the loading dose equation (because they gave you loading dose and told you it was IV) LD= (Vd x Cp)/ F if you freak out at converting units like I do

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 +0  upvote downvote
submitted by โˆ—unknown001(9)
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no need for any conversion to g/l.

as long as you can cross out the weight.

to be faster, make both to mg.

vd= dosage/conc. aka i call it vd= do/co

4microgram/ml = 4 miligram/litre

v.d= 80/4= 20

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 +0  upvote downvote
submitted by โˆ—unknown001(9)
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tip. in calculation questions. jump to the final line to know what theyre asking , making a mental note of the formula if you can remember and solve.

becuase instinctively our brain feels obligated to use all the values, and they use that to our disadvantage !

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madamestep  Another tip: Do this with every question. Read the first then last line. It'll save you time when you're trying to diagnose, just to have them say the diagnosis and ask a random basic science question. +



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