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NBME 23 Answers

reproductive repro FA19p634
Question#1 (reveal difficulty score)
An asymptomatic 30-year-old woman comes to ...
Anovulation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

oncology microbiology
digestion
Question#3 (reveal difficulty score)
A 52-year-old man comes to the physician ...
Triglyceride ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

embryology neurology FA19p479
clinical_trials FA19p256
Question#5 (reveal difficulty score)
A study is conducted to examine the ...
Phase 2 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

psych personality_disorders borderline
Question#6 (reveal difficulty score)
A 32-year-old woman comes to the emergency ...
Borderline ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

biochem cell_bio
Question#7 (reveal difficulty score)
Which of the following is present in integral ...
Transmembrane region ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

biochem drug_interactions p450 pharm
schizotypal psych borderline
Question#9 (reveal difficulty score)
A 45-year-old man is brought to the physician ...
Schizotypal ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

bed_bugs micro
Question#10 (reveal difficulty score)
A 13-year-old girl is brought to the office ...
Staphylococcus aureus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

anatomy neuro
Question#11 (reveal difficulty score)
A 55-year-old man who has a 10-year history ...
Impotence ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

micro moa
prevalence incidence
hit FA20p315
physio cholera fluids
Question#15 (reveal difficulty score)
A 26-year-old man who is a Peace Corps ...
0.9% Saline ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

biochem restriction_enzymes
Question#16 (reveal difficulty score)
Physical analysis of the isolated genomic DNA ...
Methylase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

anatomy
Question#17 (reveal difficulty score)
A 54-year-old woman comes to the physician ...
Supraspinatus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

biochem pathways 35
Question#18 (reveal difficulty score)
A 15-year-old boy has nasal polyps and ...
Enzyme B ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

biochem genetics
repro embryo
cd_markers rituximab
immuno
parkinsons neuro
endocrine
Question#24 (reveal difficulty score)
A 39-year-old man comes to the physician ...
Ferritin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

micro
Question#25 (reveal difficulty score)
A 5-year-old boy who is undergoing induction ...
Varicella-zoster virus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

genetics
Question#26 (reveal difficulty score)
A couple comes to the physician for ...
1/150 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

developmental
neuro b12 vitamins
immuno




Question#34 (reveal difficulty score)
A 64-year-old woman is found dead at the foot ...
Metastatic breast cancer ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#37 (reveal difficulty score)
A 47-year-old woman with multiple sclerosis ...
Fasciculus gracilis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#41 (reveal difficulty score)
A 62-year-old woman is brought to the ...
Pons ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#43 (reveal difficulty score)
A 65-year-old woman has the recent appearance ...
Adenocarcinoma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#46 (reveal difficulty score)
A 31-year-old primigravid woman at 28 weeks' ...
Bone ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



autonomic
Question#49 (reveal difficulty score)
Electrical stimulation of the stellate ...
Heart rate ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#50 (reveal difficulty score)
A 45-year-old woman with coronary artery ...
4.5 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#1 (reveal difficulty score)
A 26-year-old woman comes to the physician ...
Tinea corporis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Mitochondrial_Disease

Question#6 (reveal difficulty score)
A 6-month-old girl is brought to the office ...
Hepatitis B ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#7 (reveal difficulty score)
A 45-year-old man is brought to the emergency ...
Hypovolemic shock ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#9 (reveal difficulty score)
A 60-year-old man has had easy fatigability, ...
Lung ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

FA_2020_pg_157_under_Babesiosis




Question#15 (reveal difficulty score)
A child with septicemia has an antibiotic ...
28.8 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#17 (reveal difficulty score)
A 21-year-old man comes to the physician ...
Leishmania ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


_CHF_ CHF congestive_heart_failure BUN Creatinine


Question#22 (reveal difficulty score)
A 42-year-old man comes to the physician ...
Sand fly ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ






Question#28 (reveal difficulty score)
A cohort study is conducted to examine the ...
200 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#30 (reveal difficulty score)
A 21-year-old man is brought to the emergency ...
Liver ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#31 (reveal difficulty score)
A 40-year-old man has had enlarging breast ...
Spironolactone ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ







ethics
pharm lipid_disorders fibrates
Question#39 (reveal difficulty score)
A 39-year-old woman with obesity and recently ...
Gemfibrozil ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#41 (reveal difficulty score)
A 44-year-old woman, gravida 2, para 2, comes ...
Cervical canal ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#43 (reveal difficulty score)
A 2-week-old girl is brought to the physician ...
Iris ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#44 (reveal difficulty score)
A 4-year-old boy is brought to the physician ...
Dietary change ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

mnemonics
Question#45 (reveal difficulty score)
A 61-year-old man is prescribed fluoxetine ...
Raphe nuclei ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#49 (reveal difficulty score)
A 56-year-old man comes to the physician ...
Colchicine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#1 (reveal difficulty score)
A 32-year-old woman comes to the physician ...
Yolk sac ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#2 (reveal difficulty score)
A 35-year-old man comes to a new physician ...
Liver ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#4 (reveal difficulty score)
A 31-year-old primigravid woman at 32 weeks' ...
Hypoglycemia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#6 (reveal difficulty score)
A 25-year-old man has an orchiectomy for a ...
Germ cells ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#7 (reveal difficulty score)
A male newborn is delivered at 39 weeks' ...
Gastroschisis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#8 (reveal difficulty score)
A 62-year-old man with a blood pressure of ...
Labetalol ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#10 (reveal difficulty score)
An investigator is studying two drugs, Drugs ...
Area under the curve ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#12 (reveal difficulty score)
A 39-year-old man comes to the physician for ...
ฮฒ-Myosin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#14 (reveal difficulty score)
A 3-day-old male infant with Down syndrome ...
Duodenal atresia ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#15 (reveal difficulty score)
A 45-year-old woman comes to the physician ...
Myopathy ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#16 (reveal difficulty score)
A 40-year-old woman comes to the physician ...
Pituitary gland ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#17 (reveal difficulty score)
A 24-year-old woman comes to the physician ...
Accessory spleen ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#21 (reveal difficulty score)
A 60-year-old woman comes to the physician 1 ...
Amplification ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#23 (reveal difficulty score)
A pregnant 28-year-old woman is found to have ...
Lactotrope ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#26 (reveal difficulty score)
A 27-year-old woman has headaches and blurred ...
Angiotensin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#27 (reveal difficulty score)
A 30-year-old man reports increasing fatigue ...
Atrial septal defect ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#28 (reveal difficulty score)
A 10-year-old boy sustains an abrasion on his ...
Labile cells ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#30 (reveal difficulty score)
A 20-year-old woman comes to the physician ...
C1q ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#31 (reveal difficulty score)
The parents of a 1-year-old boy with a ...
Multifactorial ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#33 (reveal difficulty score)
A 78-year-old man has had progressive loss of ...
Otosclerosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#34 (reveal difficulty score)
A 34-year-old woman with a long-standing ...
Fat ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#36 (reveal difficulty score)
A 70-year-old woman comes to the physician ...
Serum sickness ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#37 (reveal difficulty score)
A 48-year-old man is referred for evaluation ...
108 to 118 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#41 (reveal difficulty score)
A previously healthy 45-year-old man comes to ...
Infraspinatus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ






Question#47 (reveal difficulty score)
A 14-year-old boy with a tibial fracture is ...
Neck of the fibula ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#49 (reveal difficulty score)
Genetic analyses of cells obtained on ...
Epinephrine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

vascular pressure physics
Question#1 (reveal difficulty score)
A 65-year-old man is brought to the emergency ...
Thromboxane A2 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ







Question#8 (reveal difficulty score)
A 36-year-old nulligravid woman and her ...
1 of 50 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#9 (reveal difficulty score)
A 35-year-old man who is a veterinarian in a ...
Coxiella burnetii ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#10 (reveal difficulty score)
A study was conducted to investigate the mean ...
99% ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#11 (reveal difficulty score)
A 40-year-old man comes to the physician for ...
Finasteride ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#15 (reveal difficulty score)
A 35-year-old man comes to the physician ...
Arachidonic acid ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#16 (reveal difficulty score)
In a study of the use of ultrasonography for ...
80% ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#17 (reveal difficulty score)
A 24-year-old man has a grade 3/6 systolic ...
Aortic stenosis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#18 (reveal difficulty score)
An investigator is conducting a study to ...
Enveloped ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ




Question#22 (reveal difficulty score)
A 40-year-old man with terminal small cell ...
Demeclocycline ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#23 (reveal difficulty score)
A 74-year-old woman comes to the physician ...
Ipratropium ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#24 (reveal difficulty score)
A 60-year-old man comes to the physician ...
Erythropoietin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#25 (reveal difficulty score)
An 85-year-old woman is brought to the ...
Donepezil ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#26 (reveal difficulty score)
A 28-year-old man has hypertriglyceridemia ...
Aspirin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#27 (reveal difficulty score)
A man accidentally touches the surface of a ...
Histamine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#30 (reveal difficulty score)
A study is planned to assess differences in ...
Cross-sectional study ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#31 (reveal difficulty score)
A 32-year-old man who lives at sea level ...
Normoblasts ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





Question#36 (reveal difficulty score)
A 40-year-old man comes to the physician ...
Postcentral ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ

Question#37 (reveal difficulty score)
A 2-year-old boy is brought to the emergency ...
Lipoprotein lipase ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#39 (reveal difficulty score)
A 44-year-old woman comes to the physician ...
Celiac sprue ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ



Question#42 (reveal difficulty score)
A 12-year-old girl is admitted to the ...
Methionine ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ





Question#47 (reveal difficulty score)
A 43-year-old woman comes to the physician ...
Left atrial myxoma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Question#49 (reveal difficulty score)
A 15-year-old boy is brought to the physician ...
Testosterone ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ


Recent comments ...

... โˆ—ferrero made a comment (nbme23)
 +45  submitted by ferrero(47)

A very similar question I have seen in Qbanks will ask why a patient with right heart failure does not develop edema and the answer is increased lymphatic drainage. I got this question wrong originally because I answered along this line of reasoning but I think in this case it all has to do with WHERE the extra pressure is coming from. In this question the pt has diastolic hypertension so you can think about the pressure as coming "forward" so constricting precapillary sphincters can prevent an increase in pressure in the capillary bed. However for right heart failure this extra fluid is coming from the OPPOSITE direction (backwards from the right heart) and constricting precapillary sphincters can do nothing (on opposite side of capillary bed) - the only way to prevent edema is to increase lymphatic drainage.

seagull  The question clearly lead us to think about Osmotic pressure by talking about protein and urine. I wonder how many people used that line of reasoning (like myself)? +20
mousie  Great explanation, I chose lymphatic drainage for the same reasoning (similar Q on different bank) +9
sympathetikey  My reasoning was much more simplistic (maybe too simple) but in my mind, systolic BP is determined by Cardiac Output and diastolic BP is determined by arterioles. Therefore, what comes before the capillary and regulates resistance? Arterioles. That's why I said that pre-capillary resistance. +41
cr  the main difference between the 2 cases is that in this case the patient has high BP +1
link981  So in kindergarten language the question is essentially asking how high pressure in the arterial system is NOT transmitted to the venous system (which is where EDEMA develops). But you know they have to add all this info to try confuse a basic principle and make you second guess yourself. (Got it wrong by the way) because of what @ferrero said of Qbank questions. +9
hello  @ferrero what are you talking about? lymphatic drainage is the wrong answer... +1
hello  ok never mind. i got it. hard to understand b/c it was a big block of text. +2
asteroides  I think they may be talking about the myogenic compensatory mechanism: https://www.ncbi.nlm.nih.gov/books/NBK53445/figure/fig4.1/?report=objectonly "Increased arterial or venous pressure also induces myogenic constriction of arterioles and precapillary sphincters, which raises arteriolar resistance (thereby minimizing the increase in capillary pressure) and reduces the microvascular surface area available for fluid exchange. For example, because vascular smooth muscle in arterial and arteriolar walls contracts when exposed to elevated intravascular pressures, this myogenic response increases precapillary resistance and protects capillaries from a concomitant rise in their intravascular pressure." +6
... โˆ—yotsubato made a comment (nbme23)
 +44  submitted by yotsubato(1182)

Was it just me, or did "age at onset in years" appear RIGHT above the number of patients, rather than the mean. Which confused me for a good 3 minutes.

fulminant_life  Definitely was the same for me. I was so confused for like 5 mins +21
d_holles  dude i almost didn't get the question bc of this ... i thought the age of onset was the actual age of onset (36) +9
mellowpenguins  Are you serious. NBME strikes again with shitty formatting. +9
yex  OMG!! Now I just realized that. Super confused and also thought onset of age was 36. :-/ +8
monkey  what is 36 supposed to be? +1
thomasburton  Think the number of people in that group +5
paulkarr  Yup...was looking at it for a good 3 min before just doing the "fuck it..it's gotta be 99" +6
arcanumm  Age of Onset is the Title of the table, which I didn't figure out until after exam was over. What terrible formatting. +4
veryhungrycaterpillar  This is straight up tatti. I was like what muscular dystrophy is showing up with an almost biphasic age of onset between adolescence and 30s? Fucked it up. +
handsome  how did you get the 99 what is your solution ? hehe +
... โˆ—sne made a comment (nbme23)
 +43  submitted by sne(59)

Alcoholic = pancreatic insufficiency. Linoleic, oleic, and palmitic acid can be absorbed without pancreatic lipases since they're just free fatty acids. Triglycerides need to be broken down by lipases before absorption.

Bile acids are the main method for eliminating cholesterol, not pancreatic enzymes

rina  also palmitic acids are fats that are synthesized de novo in the human body for storage so it wouldn't make sense to poop them out +6
... โˆ—sajaqua1 made a comment (nbme23)
 +41  submitted by sajaqua1(603)

A and J represent the gracile fasciculus, while B and I represent the cuneate fasciculus. Together they make up the dorsal column-medial lemniscal tract, responsible for pinpoint perception, proprioception, vibration, and pressure. Input is ipsilateral.

C and H make up the lateral corticospinal tract (also called the lateral cerebrospinal fasciculus), responsible for motor command of ipsilateral limbs.

D and G represent the lateral spinothalamic tract. It is responsible for pain and temperature conduction. The input arises in a limb (left lower extremity in this case), enters through the dorsal root (pictured between J and H), decussates and ascends at the anterior commissure (just behind E and F), and finally synapses on the second order neuron in the lateral spinothalamic tract. So the spinothalamic tract is responsible for contralateral pain and temperature sensation. Because our patient has lost sensation on the left, the lesion is in the right.

E and F are the anterior corticospinal tract. It is involved in motor control of proximal muscles, typically of the trunk.

nor16  good job +6
jimdooder  Pretty infuriating that this question has the standard R and L label while the other spinal cord question had it flipped. +5
larry  A and J represent the gracile fasciculus, while B and I represent the cuneate fasciculus. Together they make up the dorsal column-medial lemniscal tract, responsible for pinpoint perception, proprioception, vibration, and pressure. Input is ipsilateral. C and H make up the lateral corticospinal tract (also called the lateral cerebrospinal fasciculus), responsible for motor command of ipsilateral limbs. +2
larry  D and G represent the lateral spinothalamic tract. It is responsible for pain and temperature conduction. The input arises in a limb (left lower extremity in this case), enters through the dorsal root (pictured between J and H), decussates and ascends at the anterior commissure (just behind E and F), and finally synapses on the second order neuron in the lateral spinothalamic tract. So the spinothalamic tract is responsible for contralateral pain and temperature sensation. Because our patient has lost sensation on the left, the lesion is in the right. E and F are the anterior corticospin +3


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