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NBME 18 Answers


renal
Question#11 (reveal difficulty score)
67 yo man, fine resting tremor in both hands
Alpha-synuclein πŸ” / πŸ“Ί / 🌳


Question#14 (reveal difficulty score)
26 yo man with 27 yo wife, inability to conceive
Primary spermatocyte πŸ” / πŸ“Ί / 🌳

Question#15 (reveal difficulty score)
experimental animal with defect in an innate ...
Chronic gastritis πŸ” / πŸ“Ί / 🌳

Question#17 (reveal difficulty score)
4 day old boy, vomited throughout night after ...
21-Hydroxylase πŸ” / πŸ“Ί / 🌳

renal
Question#18 (reveal difficulty score)
68 yo man, chronically increased hydrostatic ...
Benign prostatic hyperplasia πŸ” / πŸ“Ί / 🌳




Question#28 (reveal difficulty score)
Cholera toxin is a catalyst that results in ...
Concentration of cAMP πŸ” / πŸ“Ί / 🌳





Question#34 (reveal difficulty score)
60 yo man, 1 day of fever, chills, confusion ...
Vibrio vulnificus πŸ” / πŸ“Ί / 🌳


Question#43 (reveal difficulty score)
18 yo man cracked lips and sunburned skin
Barrier πŸ” / πŸ“Ί / 🌳






Question#15 (reveal difficulty score)
38 yo man, 1 week history of shortness of ...
Aortic regurgitation πŸ” / πŸ“Ί / 🌳

Question#17 (reveal difficulty score)
65 yo woman, 1 week of swollen, painful knee
Uric acid πŸ” / πŸ“Ί / 🌳


Question#21 (reveal difficulty score)
66 yo woman, 2 days of fever, flank pain, ...
Calcium carbonate πŸ” / πŸ“Ί / 🌳

Question#25 (reveal difficulty score)
40 yo man, 1 year of orthostatic hypotension ...
Motility disorder πŸ” / πŸ“Ί / 🌳


Question#29 (reveal difficulty score)
32 yo woman, new neurologic finding; imaging ...
Inability to abduct the eye πŸ” / πŸ“Ί / 🌳

Question#30 (reveal difficulty score)
35 yo man, 4 weeks of severe midline back pain
ACTH πŸ” / πŸ“Ί / 🌳

Question#32 (reveal difficulty score)
Investigator studying vancomycin-resistant ...
Plasmid loss πŸ” / πŸ“Ί / 🌳



Question#41 (reveal difficulty score)
35 yo woman, 3 days fever and sharp chest pain
Virus πŸ” / πŸ“Ί / 🌳



Question#5 (reveal difficulty score)
82 yo woman, 24 hours of constant severe ...
Fibrin πŸ” / πŸ“Ί / 🌳



Question#12 (reveal difficulty score)
58 yo woman, 6 months shortness of breath, ...
Pulmonary hypertension πŸ” / πŸ“Ί / 🌳


Question#14 (reveal difficulty score)
2 yo boy, 2 days of fever, sore throat, rash
Erythrogenic toxin πŸ” / πŸ“Ί / 🌳



Question#22 (reveal difficulty score)
70 yo woman routine pelvic examination
Cystocele πŸ” / πŸ“Ί / 🌳

Question#25 (reveal difficulty score)
63 yo man, 2 weeks of fullness in left upper ...
Myelofibrosis πŸ” / πŸ“Ί / 🌳




genetics pedigree
Question#33 (reveal difficulty score)
4 yo boy, clumsy gait for 1 year
1/4 πŸ” / πŸ“Ί / 🌳


derm dermatology
Question#41 (reveal difficulty score)
24 yo man, 3 days of progressive numbness of ...
Myelinated primary afferents πŸ” / πŸ“Ί / 🌳


Question#46 (reveal difficulty score)
45 yo man for annual health maintenance ...
Fenofibrate πŸ” / πŸ“Ί / 🌳



Question#3 (reveal difficulty score)
68 yo man, 3 days of increasingly severe deep ...
Aortic aneurysm πŸ” / πŸ“Ί / 🌳

Question#4 (reveal difficulty score)
36 yo woman, 2 weeks of fatigue, bleeding ...
Histone acetylase πŸ” / πŸ“Ί / 🌳


Question#15 (reveal difficulty score)
45 yo man follows up 1 week after appendectomy
Gilbert syndrome πŸ” / πŸ“Ί / 🌳

Question#27 (reveal difficulty score)
54 yo man, normal renal function, receives ...
Cyclosporine πŸ” / πŸ“Ί / 🌳



36
Question#35 (reveal difficulty score)
73 yo man, 4 months poor appetite and 25 ...
Cytokine effect πŸ” / πŸ“Ί / 🌳


18



Question#45 (reveal difficulty score)
A 4-year-old boy, fatigue and irritability, ...
Microcytic Anemia πŸ” / πŸ“Ί / 🌳

Question#22 (reveal difficulty score)
A 55-year-old woman who is a physician is admitted
Alcohol withdrawal πŸ” / πŸ“Ί / 🌳


cell_bio cell_transport cell_trafficking
Question#1 (reveal difficulty score)
During a study of the regulation of ...
F (cell diagram) πŸ” / πŸ“Ί / 🌳

Question#15 (reveal difficulty score)
A 34-year-old man has a herniated lumbar ...
D (Lamina) πŸ” / πŸ“Ί / 🌳

Question#28 (reveal difficulty score)
A 51-year-old woman with Graves disease ...
Agranulocytosis πŸ” / πŸ“Ί / 🌳

Question#1 (reveal difficulty score)
A 25-year old woman comes to the physician ...
3 to 8 weeks πŸ” / πŸ“Ί / 🌳


Question#28 (reveal difficulty score)
A 68-year-old man comes to the physician ...
Cor pulmonale πŸ” / πŸ“Ί / 🌳

Question#35 (reveal difficulty score)
A 30-year-old woman with a long standing ...
Macrophages πŸ” / πŸ“Ί / 🌳


Question#10 (reveal difficulty score)
A 4-year-old boy undergoes radiographic ...
Tubular atrophy πŸ” / πŸ“Ί / 🌳

Question#32 (reveal difficulty score)
A 32-year-old man with an X-linked recessive ...
Type IV collagen πŸ” / πŸ“Ί / 🌳




Question#47 (reveal difficulty score)
A 2 month old boy is brought to the physician ...
ventricular septal defect πŸ” / πŸ“Ί / 🌳

carbamazepine FA20p518 neuro
Question#32 (reveal difficulty score)
63 yo woman, 2-week history of daily episodes ...
Trigeminal neuralgia πŸ” / πŸ“Ί / 🌳


respiratory lungs newborn

Question#16 (reveal difficulty score)
An 8 year old boy is suspended from school ...
methylpenidate πŸ” / πŸ“Ί / 🌳


antiscrambler

renal
Question#7 (reveal difficulty score)
a 67-year-old woman comes to the physician ...
amyloid infiltration πŸ” / πŸ“Ί / 🌳

micro derm dermatology
Question#40 (reveal difficulty score)
A 3 yo boy is brought to the physician for a ...
Complement activation πŸ” / πŸ“Ί / 🌳


Question#16 (reveal difficulty score)
A laboratory technician wipes down the ...
Enveloped virion πŸ” / πŸ“Ί / 🌳

Question#17 (reveal difficulty score)
A 45 yo woman comes to the physician because ...
MEN1 πŸ” / πŸ“Ί / 🌳

Question#18 (reveal difficulty score)
An 8 month old girl is brought to the ...
Enterocytes πŸ” / πŸ“Ί / 🌳

Question#20 (reveal difficulty score)
A 1 yo girl is brought to the physician for a ...
An integrin πŸ” / πŸ“Ί / 🌳

Question#45 (reveal difficulty score)
A 34 yo man 3 month history of progressive ...
Antineoplastic πŸ” / πŸ“Ί / 🌳

Question#10 (reveal difficulty score)
5 to girl is brough to physician because of ...
2 of 3 πŸ” / πŸ“Ί / 🌳

Question#1 (reveal difficulty score)
A 45 year-old-woman with joint pain due to ...
Prednisone πŸ” / πŸ“Ί / 🌳

Question#2 (reveal difficulty score)
A 72-year-old woman comes to the physician because
Extensive solar elastosis πŸ” / πŸ“Ί / 🌳

neuro
Question#22 (reveal difficulty score)
A 6-year-old boy is brought to the physician ...
Pineal gland πŸ” / πŸ“Ί / 🌳


Question#18 (reveal difficulty score)
A 1-year-old boy is brought to the physician ...
Dendritic cells πŸ” / πŸ“Ί / 🌳



Question#26 (reveal difficulty score)
A 70-year-old man has had early morning ...
Paroxetine πŸ” / πŸ“Ί / 🌳

Question#31 (reveal difficulty score)
A new antiplatelet agent is developed for the ...
67% πŸ” / πŸ“Ί / 🌳

Question#40 (reveal difficulty score)
A 30-year-old man is brought to the emergency ...
Area labeled "E" πŸ” / πŸ“Ί / 🌳

Question#50 (reveal difficulty score)
To decrease his risk for cardiovascular ...
630 πŸ” / πŸ“Ί / 🌳


Question#36 (reveal difficulty score)
25 yo with severe crush injuries to the chest ...
Basement Membranes πŸ” / πŸ“Ί / 🌳

Question#46 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Adenosine πŸ” / πŸ“Ί / 🌳



GI liver
pharm
Question#31 (reveal difficulty score)
A 30-year-old woman comes to the physician ...
Phenylephrine πŸ” / πŸ“Ί / 🌳

GI gastrointestinal
Question#13 (reveal difficulty score)
A 19-year-old man is evaluated for signs of ...
Heterotopic gastric mucosa πŸ” / πŸ“Ί / 🌳

Question#3 (reveal difficulty score)
A 34-year-old man who is a potter has burned ...
Syringomyelia πŸ” / πŸ“Ί / 🌳


Question#40 (reveal difficulty score)
A 10-day-old male newborn is brought the physician
Chlamydia trachomatis πŸ” / πŸ“Ί / 🌳

Question#15 (reveal difficulty score)
An investigator studying immune response to ...
Caspofungin πŸ” / πŸ“Ί / 🌳



Question#13 (reveal difficulty score)
At autopsy, the heart of a 76-year-old woman ...
Hypertension πŸ” / πŸ“Ί / 🌳


Question#12 (reveal difficulty score)
A previously healthy 20-year-old woman comes ...
Tick πŸ” / πŸ“Ί / 🌳

Question#22 (reveal difficulty score)
A 67-year-old man comes to the physician ...
Erythropoietin πŸ” / πŸ“Ί / 🌳



Question#19 (reveal difficulty score)
A 56-year-old man comes to the physician ...
Renal cell carcinoma πŸ” / πŸ“Ί / 🌳





Question#45 (reveal difficulty score)
24 yo woman, remain in the intensive care ...
30 πŸ” / πŸ“Ί / 🌳


Question#1 (reveal difficulty score)
a 68-year-old man comes to the physician ...
Angiodysplasia πŸ” / πŸ“Ί / 🌳

Question#11 (reveal difficulty score)
a 17-year-old boy has septic shock that is ...
alfa1-Adrenoreceptors πŸ” / πŸ“Ί / 🌳

Question#29 (reveal difficulty score)
A 60-year-old man comes to the physician for ...
Renal Artery Stenosis πŸ” / πŸ“Ί / 🌳


Question#50 (reveal difficulty score)
A full-term newborn has respiratory distress. ...
Left pleuroperitoneal membrane πŸ” / πŸ“Ί / 🌳


Question#10 (reveal difficulty score)
A 42-year old man comes to the physician for ...
radial groove πŸ” / πŸ“Ί / 🌳

Question#7 (reveal difficulty score)
A 32-year-old woman is brought to the ...
Spleen πŸ” / πŸ“Ί / 🌳


Question#5 (reveal difficulty score)
An 18-month-old girl is brought to the ...
Parainfluenza virus πŸ” / πŸ“Ί / 🌳

Question#25 (reveal difficulty score)
A 56-year-old woman is brought to the ...
Pralidoxime πŸ” / πŸ“Ί / 🌳

Question#8 (reveal difficulty score)
a 17-year-old boy is brought to the physician ...
Gynecomastia πŸ” / πŸ“Ί / 🌳

Question#33 (reveal difficulty score)
a 27 year old man comes to the physician for ...
Schizotypal πŸ” / πŸ“Ί / 🌳

Question#9 (reveal difficulty score)
A 6-year-old girl is brought to the emergency ...
Human papillomavirus, type 6 πŸ” / πŸ“Ί / 🌳




Recent comments ...

... anechakfspb made a comment on nbme18/block4/q#10 (A 4-year-old boy undergoes radiographic imaging...)
 +24 
submitted by anechakfspb(64)
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tsJu a atnr - i teha thsi *incgkf ceitrpu s'it bene on 3 BMEsN won nad rvyee tiem e'vI ttngeo it gnrwo.

cbreland  And it's a different answer every time +16
... feliperamirez made a comment on nbme18/block3/q#26 (33 yo man, diagnosed with epilepsy)
 +23 
submitted by feliperamirez(36)
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iThs iserva gnmao tsates but in tmso of the astste a 2-1 arye free ireuesz diroep si rdireequ rfo icetpilep ntspatie ot egt trhei islcene

baja_blast  Didn't realize I was in law school +35
... aneurysmclip made a comment on nbme18/block1/q#26 (50 yo woman, chronic obstructive pulmonary disease)
 +22 
submitted by aneurysmclip(189)
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ODCP is alulusy aaitsdseco wthi Pyuarlomn irHeoen.ynstp ehT maerenix ltsel oyu thta ehert si a uold omnlpuyra tpmonncoe fo S2 ei: P2 (Lodu 2=S/2P anrmyPuol synHnep)t.ioer CevF:V1F si sutj ealedrt ot OC.DP The onetiqus si gsinka athw si RAEESDECD ni hte omayuprln ACULRVSA MOHSTO LMS.UCE od nto gte dfunosec hwit the ilne nsigtta heret is eerecsadd niuifdgsf ccptaiya orf OC. teh tqinosue ni'ts skgnia oatub ah.tt

In uonyalpmr ennpoyeihrts teerh is na maalinecb nwetebe aniitvodsalo acneussbts nad vocsnstaos.rrtoic hteor free oru istoralvasod uldow be seeaercdd e:g iNctir dOiex

if ti adske adesnr,iec ouy coldu go with nEeinthldo emremebr( the nntloieehd niasotagstn seud rfo tt/ of mPlu TNH i:e nnestaob rsy ro eavg osme eraxt foni ubt all fo it si tirtampon ebuscae hety cna ksa tish cnotepc in nyam wyas

... match95 made a comment on nbme18/block2/q#32 (Investigator studying vancomycin-resistant <i>Enterococcus faecalis</i>)
 +18 
submitted by match95(53)
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srsoapnnioTti of eht navA egen ofmr yiaesncmsoirctta-nvn nrccuesctooE si woh ti tsferanrs sanicrtes.e They ues rptnsssaoon hcwih are tloecda no ldps.msai If ouy evah pdlsami slos, uoy nw'to ehva rpons,otssna adn aiessenctr illw draeece.s

azibird  Why can't this be a point mutation? +6
thrawn  FA says transposition is responsible for antibiotic resistance and plasmids are for transferring the genes of toxins (though UW says also antibiotic resistance). Make up your minds sheeple +
mariame  The most common Vancomicin resistant genes, vanA and vanB are found in a transposon. These have been transferred from Enterococcus to a multidrug resistance plasmid in Staph aureus. the super multidrug resistance plasmid now contains resistance genes against lactams, vancomycin, aminoglycosides, trimethoprim, and some desinfectants. +2
an1  @thrawn I recall that too, but I think it said transposition was antibiotic resistance and UW said transposons was for multi drug resistance +
... azibird made a comment on nbme18/block3/q#37 (During a clinical study of calcium and phosphorus...)
 +18 
submitted by azibird(227)
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atnzosCo liyhgoPyos t6h E 456p

Regtaunlio fo anVtimi D Ssr yeesnhtehtihW het raeln ellcs ecudpro -1,52 ilocchhixfdcaeyrroeloyld (eth itacev eoleai)mtbt ro 4-if2aeriryhodo52chccylxlld,eo et(h eicitnav a)elttiombe dsepnde on teh ssβ€œβ€tuat fo +a2C ni eth .bydo heWn +2aC is s,utefifnic wtih an deaqutae ieydatr aintke fo a+2C dan oanmrl or anedesric psamla +Ca2 ntnoaeico,rcnt hte netaviic bmlttoieea is neeelytlfrraip yseeznstihd sbeecua eerth si no dnee for omer .+2Ca hWen +aC2 is iuseci,nfitfn ithw a wol iaertdy tienak fo a+C2 nda esceaddre aplmas 2C+a tanoictn,cnore teh aitcev eletmtoiba si nltfyprreiaeel nezihtsdyes ot esrune that dilntodaia +2Ca wlli eb obdsbera rfmo the arinnetlottsigsa ratct.

cbreland  Constanzo is the best resource, change my mind +
... apurva made a comment on nbme18/block3/q#45 (A 34 yo man 3 month history of progressive rash on...)
 +16 
submitted by apurva(93)
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SHIT SI KO'SsPIA OMASRCA g=;&t= gevi ciaesptnitonal

"TSHI SI TSUJ TO TEGEHLNN HSIT AR,NWES VENRE EREV YPA STHI ,TIES ADENOTUCI OHUDSL BE EFER RFO L"AL!

michaelshain2  It's unfortunate that I had to pay in order to get these answer explanations. They aren't as informative/thorough on freenbme :/ +5
jamaicabliz  So annoyed, I thought it was asking us to recognize that it could also be Bacillary Angiomatosis from Bartonella, which also presents in the immunocompromised... So any different study materials stress the importance of differentiating them, given they look very similar. +2
drdoom  @apurva tell that to my loan officer!πŸ˜πŸ˜‚πŸ˜‚ +
cbreland  Between this and bacillary angiomatosis, I think it came down to Kaposi being more likely with a HIV patient and also the lesions being purple +
jsanmiguel415  It says that "in addition to treatment with highly active antiretroviral therapy" which makes me think this is HHV-8 -> Kaposi sarcoma. Bartonella is bacterial and would be treated with azithro + doxy +
ih8payingfordis  The reason why this isn't Bacillary Angiomatosis is because the stem states that the rash is NOT painful. In BA, the rash is painful! +2
... match95 made a comment on nbme18/block1/q#32 (52 yo man with chest pain and shortness of breath)
 +15 
submitted by match95(53)
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shTi dwulo sujt be hte anrmlo ornspese of rou ysenkdi to when ew td'no irdnk werta henuog aak( sutj nl).oram

mrioalPx buuetl is cistoion eeausbc we aer osebnrirgba BTOH a+N dan HO2.

acaulM sdnae si hcitpyono bsauece it si einnsgs the aldits oedulovntc luetbu -- eht otms LTIUED rapt of eht .npneroh eemmRrbe hte ncnturecerotru enhgxcae sytmse - citkh siengcdan mbil si islong aNCl uerni( esgt sles actdnecoentr sa ti n)s.scdea

eaydlMrul leingcctlo cudt si hotenpicry euesbac ew are birbonagers all het eatwr kiamgn eht ernui eomr enc.ocenrttad

... famylife made a comment on nbme18/block1/q#45 (55 yo man; father and brother died of myocardial infarct at early age)
 +15 
submitted by famylife(103)
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iteDesp" ninbiiitoh fo oAC-HMG srdtceaeu by ns,itsat llecs ecsmtaopne yb ragcnsiine nmezey pseixronse rveeasl .dflo Hvewero, het loatt ybod tsocrleleoh is drucede yb %204%–0 edu to asenicerd psinesoxre of LLD ecoetrspr erfat tisatn antitin.md"oaris

g--iwwrntihoesmtrpceaggcochcahoiibotesr.etpetis/c/./cto-:enocdliomasc/s-l-yynembwd/mclui

md_caffeiner  fuck GoT, knowledge is power +
dhpainte22  Another bullshit question that should've been straight to the point. Statins increase ldl receptors and inhibit hmg coA reductase. This should be simple but nbme can't live with that :( +4
jurrutia  I think they want to test not just your understanding of how statins work, but also the basic principle that when you block X the body tries to compensate by upregulating X. +5
... wishmewell made a comment on nbme18/block1/q#11 (67 yo man, fine resting tremor in both hands)
 +14 
submitted by wishmewell(53)
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I saw eofsdunc ewteneb -Ahalp enniulcyS nda u.aT is hT pnttiea hsa nikanrposs eadiesss nad usht we douwl ese phAal snlunec.yi

aTu is nese ni ntepiats wtih sPcki esds,iea aka rapeotnomtrolF neamdeti DNA zemashierl aies.sed gea p 45.0 AF 2018

baja_blast  FA 2019 p. 508 +
jbrito718  The gross image also shows the medulla, where you can see some darkness around the edges, reprentative of the substantia nigra which is affected in Parkinsons. Another hint +1
... merpaperple made a comment on nbme18/block1/q#14 (26 yo man with 27 yo wife, inability to conceive)
 +14 
submitted by merpaperple(30)
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nI imessio ,I eht ottgcymeea tspisl frmo a lsgnie clel YX(X)Y &;-gt 2 ellcs XX( + .)YY In mseiosi II teseh tow sllec psilt nagia tg;-&( X + X, Y + ).Y eHnce in rredo fro a earhtf ot ssap on boht an X adn a Y ooesrmohcm ot his ons e(g in lnetKierelf r,mesndoy /w YXX mh,c)smoroeo a retdpsami stmu ncatoin otbh na X adn a Y omeohc,smor hchiw masen tath etreh swa an oerrr ni oieisms I. Teh gsaet at hiwhc oseiims I uorccs is the yrrmiap csemoartetpy.

b1ackcoffee  Brilliant question and explanation! +2
jbrito718  PICTURE PLEASE +1
... amirmullick3 made a comment on nbme18/block3/q#25 (63 yo man, 2 weeks of fullness in left upper quadrant of abdomen)
 +14 
submitted by amirmullick3(66)
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siTh pttnaei sha a rdy ap,t iwhhc si esne in bflreissyomio nda ltiascpa .ianema Teh nbalomra RBC aer stmo leylki yctoacerds atop(derr lsel.)c

LAM ouldw hvae ruae sdro adn nyma incitruclag ls,bleosaytm tub nor anmrolba R.CB

L,CM edfdien by eth t;[]229 lhhaepPadili or,cemhooms wlli vaeh nyma arutme dan ntrgumia rlueyco,sagnt itwh a wol LPA ceeubas shit is ont a deoluiemk netc.rioa

olciemtDysiopye nymdoesr si het aesm sa a dieslmctyapsyols snodyrem, chhwi rae a rgpou fo ccesnar htwi aurimemt RBC in the beno aomwrr tath od ont cmeboe au.retm donhilye_/Maiscti:ensrsy.ypt/kodpwimap/gtdroee./isikwl

nsateEils ihhcoroaybmemtt (hhciw si otn seetlsina e)htyycpiolam si jstu a raer ecranc itwh ihhg sel,taetlp ihwch srspeten wiht mlnarabo obldo ci,lgtotn aidgenl to iro,smbhtos sost,ekr dan E.P

ylmeotycaihP vare ahs yevr aegrl BCR asms nda wol POE ued ot enagteiv k.fecabde It is ued to a J2AK uamottin nda oasl ahs gihh CBW dan l.laepttes Oru patenit is cmei.an

//.ucw/mblwwetssup:huovy.tetmloie

... sugaplum made a comment on nbme18/block3/q#6 (32 yo woman, diagnosis of hyperparathyroidism)
 +13 
submitted by sugaplum(453)
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th4 npeghlayar cpohu evsgi sire ot esriupor ayrshadt.opir
FA 1290 pg 076



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