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 the questions from NBME I can remember, let us discuss  



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Author6 Posts
  #1

1 one kid got vaccine, but the antibody function is abnormal. it can induce ADCC( complement mediated), but not macrophage mediated lysis.answers I can remember is
a the light chain of Ab dysfunction b heavy chain dysfunction c dysfunction of maturation of ab, isotope shift .......
2 fever 4 days after operation. blood cuture get Staphylococcus aureus . where is the origin of infection. answers I can remember:
would ,stool, sptum... I choose sptum
3 how does AMP increase the gluycolysis ?
4 the patient has neoplasia in pancreas, which secrete much gastrin. which drug should be used before the surgery? I choose omeprazole




  #2

Hi,
As the questions and answers are not very clear,I'm not sure how to answer them.Anyhow I'll try and give it a shot.

1)A.....maybe because the macrophages can't recognize the Ig surrounding the foreign material and so can't lyse the foreign protein.And usually the light chains are the site where macrophages can bind on to the Ig...........just a wild guess!!
2)wound...infected wound leading to post surgical sepsis....also mosr common cause of fever post surgically.what prompted you to say sputum?
3)AMP increases activity of Phosphofructokinase-1 so increasing the rate of Glucolysis
4)zollinger-Ellison's syndrome.....so omeprazole makes sense.....I'm not sure what the other choices given as??


  #3

for no.3, the wound infection usually happen one week after the surgery. if temperature go down and up again, would infection should be suspected. I think pneumonia is very likely 4 days after surgery.
thank you for other ideals.


  #4

Hi Jessie,
Regarding Q.3,I'm not sure the time duration of different complications arising post-surgically as I haven't given step 2 yet.However I just checked regarding infections caused by Staph. Aureus.It is a normal flora of skin and nasal mucosa.And spreads via sneezing,hands also from surgical wounds,lungs of cystic fibrosis....assoc. with food poisoning mainly ham/canned meats/custard pastries and potato salad.

The predisposing factors are surgery and contamination of surgical packing/sutures or any foreign body;ventilators
severe neutropaenia,IV drug abuse and chronic granulomatous disease.

I think it can be sputum if the patient was on a ventilator post-surgically,however since the question doesn't mention it....I still feel its from the surgical wound.The swinging temperature you mention is due to suppuration/abscess.However since a culture is being grown from the blood it means its a sepsis which is usually characterized by a high grade fever with chills.

Thanx for asking the questions by the way.....they helped me learn new things.....do you have more questions to post??


  #5

thank you for your participation. I am keeping on with NBME , and I will post more questions later.


  #6

Hi, I think is a good idea to discuss NBME questions but why don't you guys go to the subjects forums to discuss those.
Just a suggestion :roll:





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