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NBME 25 Answers


Calcification
Question#1 (reveal difficulty score)
A 75-year-old man has decreased exercise ...
Calification ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#2 (reveal difficulty score)
New reagents are being designed to treat ...
T lymphocytes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

endo
Question#4 (reveal difficulty score)
Assuming the PPV of a test is 50% and the NPV ...
(the first table) ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#5 (reveal difficulty score)
A 43-year-old woman comes to the physician ...
Hepatocytes ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–


Question#7 (reveal difficulty score)
A 68-year-old man has a surgical excision of ...
Kidney ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–




Question#11 (reveal difficulty score)
The biologica effects of thyroid hormone and ...
DNA-binding domain ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–


Question#13 (reveal difficulty score)
A 45-year-old woman has had progressive ...
Left atrium ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–








Question#21 (reveal difficulty score)
This graph best depicts the natural history ...
Yellow fever ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–



Question#24 (reveal difficulty score)
A 52-year-old woman with breast cancer comes ...
Contraction ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#25 (reveal difficulty score)
A 50-year-old woman comes to the physician ...
Meningioma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–



Question#28 (reveal difficulty score)
A 28-year-old woman comes to the physician ...
Membranous ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–


Question#30 (reveal difficulty score)
A 26-year-old man comes to the physician ...
Pudendal ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#31 (reveal difficulty score)
A 62-year-old man comes to the physician for ...
Contemplation ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–








Question#40 (reveal difficulty score)
A 69-year-old man with hepatic disease and ...
IgA ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–



Question#43 (reveal difficulty score)
A 53-year-old woman comes to the physician ...
Rectus abdominis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#44 (reveal difficulty score)
A 2-month-old boy is brought to the physician ...
Attachment ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#45 (reveal difficulty score)
A 53-year-old man comes to the physician for ...
trans-Unsaturated ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#46 (reveal difficulty score)
A 1-month-old male newborn is brought to the ...
132, 3.2, 90, 37 ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

hemeonc
Question#47 (reveal difficulty score)
A 33-year-old woman with HIV infection is brought
Non-Hodgkin lymphoma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Immuno
Question#48 (reveal difficulty score)
A 20-year-old woman comes to the physician ...
C1q ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

endo
Question#50 (reveal difficulty score)
A 57-year-old man is brought to the emergency ...
Parathyroid adenoma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Neuro
Question#2 (reveal difficulty score)
A 50-year~old woman comes to the physician ...
Meningioma ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

endo
immuno
Question#4 (reveal difficulty score)
A 30-year~old woman, grav1ida 2, para 1, who ...
Graves disease ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–


Question#2 (reveal difficulty score)
A woman who weighs 70kg (154 Lbs) is ...
5 L ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–


Question#4 (reveal difficulty score)
A 30-year-old woman has polyhydramnios at 25 ...
Anencephaly ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#5 (reveal difficulty score)
A 45-year-old man has shortness of breath. He ...
Protease inhibitor ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–



Question#8 (reveal difficulty score)
The breakdown of dipeptides and tripeptides ...
Intestinal mucosa ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–



Question#11 (reveal difficulty score)
A 36-year-old man who is seropositive for HIV ...
Cytomegalovirus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–



Question#14 (reveal difficulty score)
A 29-year-old man has a left testicular mass. ...
Cryptorchidism ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#15 (reveal difficulty score)
A 45-year-old man is brought to the physician ...
Schizotypal ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#16 (reveal difficulty score)
In a sample of 100 individuals, the mean ...
2.5% ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–




Question#20 (reveal difficulty score)
An investigator working in a large health ...
Convenience ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–





Question#25 (reveal difficulty score)
A 3-year-old boy is brought to the emergency ...
Mitochondria ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–


Question#27 (reveal difficulty score)
A 19-year-old man is admitted to the hospital ...
Left Achilles tendon ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#28 (reveal difficulty score)
A 65-year-old man comes to the physician 2 ...
Epidermis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–






Question#34 (reveal difficulty score)
A 56-year-old man with alcoholism comes to ...
Duodenal pH ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–






Question#40 (reveal difficulty score)
A 35-year-old woman comes to the emergency ...
Heroin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–

Question#41 (reveal difficulty score)
A 55-year-old woman comes to the physician ...
Supraspinatus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–






Question#47 (reveal difficulty score)
A 45-year-old woman with chronic Hepatitis C ...
Cryoglobulin ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–








Question#5 (reveal difficulty score)
A 46-year-old woman with systemic lupus ...
Paradoxus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–



Question#8 (reveal difficulty score)
A 25-year-old woman, gravida 2, para 2, comes ...
Bartholin abcess ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–




Recent comments ...

... yogurt-dimple made a comment (nbme25)
 +1  submitted by yogurt-dimple(3)

Am I crazy, or does the question stem imply that this was inherited paternally?

raspberry-muffin  In this question sounds like inherited paternally , but this muscle biopsy confirmed Mitochondrial inheritance. Muscle biopsy: Immunohistochemistry typically shows ragged red fibers, which are caused by sub-sarcolemmal and inter-myofibrillar accumulation of defective mitochondria in muscles (mitochondria stain red). Probably Mother has the same condition too. +
yogurt-dimple  Gotcha. Yeah, the red ragged fibers tipped me off to mitochondrial myopathy, but because the stem implied paternal inheritance, I figured there was just another disease I had forgotten about that presents with them. +
drdoom  @raspberry-muffin I'm not convinced. It is highly unlikely the NBME would write this question and expect you to "assume" mom has condition without making any mention of mom. Plus, it is simply highly improbable that myopathy is present in both mom and dad lineage. That seems off to me. +
drdoom  @yogurt-dimple, I think this a key line in the explanation: โ€œHowever, there are additional mutations that affect mitochondrial RNA translation, trafficking and incorporation of respiratory protein complexes, and maintenance of the inner mitochondrial membrane that can also lead to mitochondrial myopathy.โ€ +
drdoom  Yes, they say, "Mitochondrial diseases are strictly inherited through the mother" but this is not a mitochondrial disease โ€” this is a "non-mitochondrialโ€“derived" mitochondrial myopathy; yes, mitochondria are affected but the mutation is in somatic (nuclear) genes that govern the maintenance of "healthy mitochondria". This is because the mutation affects the function/operation of mitochondria but the mutation itself is in the nuclear DNA (which control something about the "quality" of mitochondria but what exactly is not yet known). +
... โˆ—drdoom made a comment (nbme25)
 +1  submitted by drdoom(1200)

This question might be tricky because the mutation of interest here is inherited from the dad side (paternal) but affects the mitochondria.

That is, the mutation is not a mutation of the mitochondrial DNA; it is of nuclear DNA which affects mitochondrial function and quality. (Mechanism unknown.)

In their explanation, the NBME says, โ€œMitochondrial diseases are strictly inherited through the motherโ€ but that is incorrect; it would be more correct for them to have said: Mitochondrial DNA mutations are strictly inherited through the mother.

That is, you can have mitochondrial problems that come from your dad. Mitochondrial DNA mutations, on the other hand, come only from mom.

So, the stem describes a โ€œmitochondrial diseaseโ€ but it is not a mitochondrial disease dervied from a mitochondrial DNA mutation.

Yes, mitochondria are affected but the mutation is in nuclear DNA that governs the maintenance of "healthy mitochondria".

This explains why dad and dad's brother show the same โ€œproximal muscle weakness of the lower extremitiesโ€.

drdoom  Clarifying further: The disease of interest is better described as a "non-mitochondrial DNAโ€“derived" mitochondrial myopathy. It's a mouthful, I know. Yes, mitochondria are affected but the mutation is in somatic (nuclear) genes that govern the maintenance/operation/function of "healthy mitochondria". This is why it is being inherited through the dad and yet manifests in mitochondrial dysfunction. +
... โˆ—shak360 made a comment (nbme25)
 +1  submitted by shak360(14)

GVHD is due to DONOR T lymphocytes recognizing and targeting recipient cells (usually GI, skin, and liver) [diarrhea, maculopapular rash, hepatomegaly, jaundice]. This also means that this is a Type IV hypersensitivity such as contact dermatitis (poison ivy or a nickel allergy) and the PPD test. Sometimes this is taken advantage of (GVHD is usually seen in bone marrow transplants) in the scenario of bone marrow transplants for leukemia patients where we can yield a "graft-versus-tumor" effect.

shak360  Also see this question in block 2. +
... โˆ—namesthegame22 made a comment (nbme25)
 +1  submitted by namesthegame22(16)

Vitamin D plays a role in serum calcium and phosphate homeostasis by promoting the intestinal absorption of calcium and phosphate.

Vitamin D deficiency typically leads to: decreased intestinal calcium absorption, hypocalcemia, increased PTH secretion, and increased PTH-mediated bone resorption.



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