DrVirgo
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Have you all done the NBME sample assesment?
There are 10 questions. go to: Click here to review Sample Assessment.
on this page and do the 10 questions... https://external1.nbme.org/nsasweb/servlet/mesa_main
Lets compare answers:
Here is what I got:
1. E
2. B
3. E
4. E
5. A
6. D
7. D
8. C
9. A
10. B
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| robin082006
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1. F, this is acute bacterial orchitis in young male so F is the best choice
2. B agree
3. E gree with you
4. E Agree
5. D, Glutaryl transferase increases in liver metastasis but not in bone metastasis
6. D agree
7. D agree
8. C agree
9. A agree
10. D since the testes does not descend in this patient so I go with this choice because dihydrotestosterone is responsible for this decending.
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| nadiabarati
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1.A because we didn't see gram negative cocci inside the neutrophils. remember gram stain for gonorhea in men is more accurate than women.
2.B
3.E
4.E
5.D
6.C please be careful it says she can not botton her left sleeve and can not tie her left shoe and she is supposed to do these things with her right hand. We can not botton our left sleeve with our left hands!!
7.D
8.C
9.A
10.B there is no testes so the neonate is not a male.
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| alexaE
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a
b
e
e
d
c
d
c
a
b
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| robin082006
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I do not agree with you about q10
for question 10, B must be associated with aldosterone dificiency symptoms
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| DrVirgo
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1. Didn't see organisms so I thought it can't be bacterial, and there is unilateral orchitis so I say Mumps. (E)
5. D is right. If GGT and Alk. Phos. comes from the liver means hepatic mets.
6. She is ignoring the left side of her face, not grooming on the left, and she CAN draw a clock face 12-6 (on right), but CAN'T draw the LEFT side of the clock.
So she is ignoring her entire LEFT side of the world.
So the lesion is on the opposite side (RIGHT PARIETAL LOBE)...
Hemineglect is usually on the non-dominant parietal lobe so Right Parietal is my answer. (D)
10. Ambiguous genetalia, virilazation of the clitoris, and no testes AT ALL (not present in the labioscrotal swelling or inguinal canal) in a neonate... So the problem is not that they did not descend, the problem is that they did not even develop. I go with (B) 21-OH deficiency.
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| nadiabarati
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Dr virgo. Q6 she has right hemiparesis. Try to read Q one more time. For ignoring the left side the lesion must be in the left side.
robin she has clitoris and no testis in inguinal canal and...the question didn't give a full grown scenario but asked about the most likely diagnosis.
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| nadiabarati
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Dr virgo about Q1, Do we have urethral discharge in mumps?
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| nadiabarati
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why right hemiparesis?!!
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| DrVirgo
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1. Numerous neutrophils... I missed that, so ok, bacterial... you all are right...
A. 
6. Nadia, she does NOT have RIGHT Hemiparesis...
She is ignoring the LEFT side of her body: "not taking care of herself... Hair on LEFT side is poorly tended....not buttoned left sleeve... not tied left shoe..."
(Althought you are right, you can't button your left sleeve with your left hand, what about all the other stuff?) This is a classic case of hemineglect and the clock face confirms it.
The right cortex controls the left side of the body, and the left cortex controls the right side of the body, so if she is ignoring the LEFT side, the problem is in the RIGHT side. (Right Parietal)... I'm sure of this.
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| DrVirgo
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From Kap anat:
"The integration of visual and somatosensory information is important for the formation of the "body image" and awarness of the body and its position in space. Widespread lesions in areas 7, 39, 40 in the non dominant right parietal lobe may result in unawareness or neglect of the contralateral half of the body known as asomatognosia. Although somatic sensation is intact, the patients ignore half of their body and may fail to dress, undress or wash the affected (left) side. Patients will have no visual field deficits, so they can see, but deny the existence of things in the left visual field. Asking them to bisect a horizontal line produces a point well to the right of true center. If asked to draw a clock face from memory, they will draw only numbers on the right side, ignoring those on the left. The patients may deny that the left arm or leg belongs to them when the affected limb is passively brought into their field of vision. Patients may also deny their deficit, an anosognosia."
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| nadiabarati
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Thanks a lot Drvirgo. You are totally right. I was so careless about Q6!!!! there is just lef side neglet not any paralysis
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| DrVirgo
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You are welcome.
Thanks for correcting me on #1.
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| nadiabarati
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But I'm not sure about number 1 yet!!! Why NO organism?!!
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| DrVirgo
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Oh, you can't see the organisms because Chlamydia is an obligate intracellular bacterium (so is Rikettsia). They can't make ATP.
There are two stages: the reticulate body and the elementary body.
The elementary body is the one that is infective, and the reticulate body is the one that grows inside us. (the reticulate body contains the elementary body, which can be passed on).
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| robin082006
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For question 1 mump is absolutely wrong because this patient has BACTERIAL ORCHITIS (NEUTROPHILS DISCHARGE, 36 HOURS LATENCY, PAIN)
I did a similar in Goljan, he said that in some cases we do not find Gonococcus by gram stain--> need PCR.
Q1, answer must be F or A, other choices are not suitable.
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| robin082006
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For Q1, I review Goljan again, I go with A now
Sterile Pyuria: C. Trachomatis, M. Hominis, My. Tuberculosis, U. Urealyticum.
End of discussion about question 1
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| nadiabarati
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Drvirgo, if we can not see clamydia because of being inside the cell. So why we can see gonococcus inside the neutrophils. So intracellular organisms can be seen!
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| DrVirgo
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Good question Nadia... Gonococcus (gram negative coccus) can be stained with gram stain, but Chlamydia's cell wall lacks muramic acid and therefore it is NOT seen on Gram Stain.
Lab diagnosis of Chlamydia:
-You need microimmunofluoroscence to visualise it or the cytoplasmic inclusions can be seen on Giemsa-, iodine or Fluorescent-Ab-Stained smear or scraping.
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| DrVirgo
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Also I think it has to do with the differenct between Obligate Intracellular and Facultative intracellular. I know Chlamydia is obligate... Not sure about gonococcus.
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