| Author | 6 Posts |
monam84
Forum Senior
Topics: 35
Posts: 135
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I would greatly appreciate some help with these NBME problems, as my exam is in a few days, thanks in advance.
1.) A 55 yo male with a 2 month history of intermittent severe sharp abdominal pain occurs after meals and last 30-60 minutes. No fever, diarrhea, or weight loss and no abn on physical exam.
A.Acute cholecystitis
B.ascending cholangitis
C.biliary colic
D.primary biliary cirrhosis
E.sclerosing cholangitis
My guess: I would say acute cholecystitis (A.) but Im not sure of why it wouldnt be the other ones.
2.) What leads to cardiac arrest in Diabetic ketoacidosis:
A. Na
B. Cl
C. K
D. Hco3
E. glucose
F. acetone
G. ph
My guess: I would say K because the person has DM type 1 and without insulin the patient would get hyperkalemia (widened QT torsades?)
3.) Which of the following neural crest derivatives is involved in congenital absense of pain perception?
A. Large diameter DRG,
B. postgang parasym
C. Postgang symp
D. Schwann
E. Small diametes DRG
I had not idea!
4.) Which is the rational for advising a decrease in dietary nacl in patient with hepatic disease who develops edema?
A.Edema fluid has an increase concentration of chloride
B.GFR is increased
C.injured hepatocytes are more permeable to sodium
D.secondary hyperaldosteronism is present
E.serum globulin concentration is increased
My guess: (C) looked familiar, but I cant tell you the mechanism. Does anyone know it?
5.) ARDS from Klebsiela pneumonia septicemia is due to which mediator released form macrophages that initiated the process that lead to death.
A. Alpha antitrypsin
B. C3b
C. CRP
D. factor 12
E. ifn-gamma
F. Il-8
G. DAF
H. tumor necrosis factor
My guess: TNF seems to be implicated in a lot of things (septic shock for example) but Im not sure of how this would lead to ARDS, maybe chemotactic to neurophils? I know this is high yield, HELP!
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| doc179
Forum Guru
Topics: 67
Posts: 1,217
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1) my answer is billiary colic. If he had acute cholecystitis, he would have fever and all that stuff ( signs of distress and inflammation).
2) I think I would also go for the same.
3) I think its either A or E, dont know the right answer yet. Will check this one and let you know.
4) I think its D, since the advice of restricting Na is cos he has edema and not cos he has hepatic disease.
5) TNF is the answer. I dont know whether the link I am going to type below is going to help you. Hoping that it might: http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd...
http://www.bio.davidson.edu/courses/immunology/St...
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| lq2006
Forum Elite
Topics: 43
Posts: 382
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1. C
2. C
3. don't know
4. C
5. H
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| Addicudo
Forum Guru
Topics: 124
Posts: 615
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1. C
2. C
3. A
4. C
5. H
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| Addicudo
Forum Guru
Topics: 124
Posts: 615
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Two pain pathways ... Fast and Slow
Fast ... Larger diameter fibers ... 2-5um in diameter ... responsible for the sharp, localized, bright pain ... Ad(Delta) pain fibers..
Slow pain .. Smaller diameter fibers .. 0.4-1.2um in diameter ... responsible for the slow, diffuse pain .. C pain fibers ... !!
So now the question ask .. absence of pain sensation ... !! So .. what disease is it .. that causes absence of pain .. and if it's Fast pai only .. or Slow pain only .. !! the answer will depend !! ..
Any one knows what Disease is it ??
I saw a case in HOUSE MD though .. !!!!! He didnt teellll what pathway thugh 
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| Addicudo
Forum Guru
Topics: 124
Posts: 615
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CIPA http://helium.vancouver.wsu.edu/~woodc/CIPA.html
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