801-850

[semin]

801.
Q) Other than CNS injuries at birth, which one (Hypomagnesemia or Hypocalemia) is likely to cause seizures in the neonate?


A) HYPOcalcemia.


802.
There are two stories I personally heard of of students facing Step 1. One guy was doing extremely well on his tests and then got AN IMPOSSIBLE version of step 1 and failed...barely. This reminds me of a lot of you e mailing me and letting me know how one time you got an easy version and then you got an IMPOSSIBLE version.

The other can happen too. Another guy in my school failed the first time, and then took it again. BUT...he said he did NOT study much for the second time and I believe him. BUT...HE PASSED easily. I think with a 216 or something. But when asked why, he said he "just happened" to get a version of the test which was more straightforward and less weird out of the world molecularbiophsiobiochem questions that MANY SAID THEY NEVER EVER SAW ANYWHERE IN ANY REVIEW BOOK OR HY CONCEPT BANK! So, you HAVE to assume there is A LOT of luck in this..

If you fail badly because a test was all about Immunoanatomy or some weirdo Microhistology (I can imagine this that the NBME "seems" to develop new science areas entirely)! then just stop and know that many have faced the same out of this world test form.

Just today, someone told me that even though they did ALL of QBank over and over I think 1.5 times, they did not get a SINGLE QUESTION that even resembled their actual TEST!!!! So, as I said these concepts and QBank and others are there to assess your retention since the material overlaps. But, the moral here is pray and be ready for anything and everything!

After hearing about some of the exams some of the fellow family got, I and other higher scorers may have FAILED TOO! Even browsing other forums, I read of USA super students at the top of their class who are AOA suddenly FAILING the STEP 1!!! It seems impossible but you have to believe me that this is TRUE!

This Step 1 is unlike any other test I think on earth. There is SO MUCH VARIATION! Again, today some guy emailed me and PMd me that my HY concepts were so helpful and he saw so many concepts repeated...but then others said their test was something out of the twilight zone and could not even figure out what the questions were asking!!!

Tommy


803.
Dear family, I also know another student because HE happens to be a friend of mine. He FAILED a couple of times on the boards and did not know WHAT THE HECK to do. BUT, then, he got this SUPER HIGH SCORE. There is NO reason at all for me to lie to you, but I could not believe this...this happened a few years ago and he got a 255!! That is TRUE. A 255/99!!! He is now a radiology resident in New York City and cannot still believe it. And his scores on Step 2 and 3 were FAR FAR lower! And this guy was just a normal student! And he said his test Step 1, totally aimed right where he put his focus on. For example, he said he got SO MANY SIDE EFFECT questions. One after the other... And a lot of "Buzzwords" that are by nature, easily because the differential is narrow. Like Koplick spots...they are SO specific for measles... (I heard in the last couple of years the NBME started targeting their "buzzword" questions and erasing a lot of them. It does not mean forget about them, but realize the NBME is always trying to make the test HARDER, not easier.

So the message that is so important is that you JUST DON'T KNOW what is gonna happen! That is the point of this impossible test. Just have faith that the impossible will become "possible".

Recall that even though some stats point to an average of I think 70% passing overall (notably higher for USA students). Know that his statistic figures in those that have taken the test a bunch of times and does not break it down state by state, country by country. THEREFORE, the test is much harder than the superficial stats suggest. A few of my CLOSE CLOSE friends at the Caribbean schools learned quietly that their pass level was around 20% at their school (I won't name which schools though). That means a whopping 80% are failing. Again and again. But I heard of one guy here now in the USA who finally passed, and I am not sure how many times he took the test, but he looks older like in his mid 40s when I met him in a rental building office.

Therefore, DO NOT get discouraged, but understand that you are FAR FROM ALONE!!!! This test is an impossible test that many who BUST themselves studying make possible the impossible. DO NOT lose hope! It can and will be done, but you have to study like mad ALL the subjects and sub subjects, and PRAY hard and then click that MOUSE PAD and hope that the questions coming up will give some mercy to you. Amen!

Tommy


804.
Dear Family,
I forgot to mention another student who I knew PERSONALLY. He got a 39 on his MCAT and ended up at one of the most respected and competitive med schools in the country. But I heard that his USMLE Step 1 performance was not good, so much so he would not even mention it or speak of it except for giving a bunch of reasons why his score was low. But he had no trouble telling everyone his MCAT score. This guy is a nice smart guy but it is another reason why one can never know about what is "behind the Wizard of Oz" curtain. What will you find? No one knows, but the point here is that everyone is under pressure from the hardest test on earth.

Tommy


805.
Case: Patient presents with a infiltrating glioma in his brain. He is showing progressive right sided weakness of the limbs. His LEFT side of his tongue is weak though! The face is asymptomatic. He is also having trouble swallowing and talking clearly. WHERE IS THE LESION?


A) BRAINSTEM lesions are same sided (ipsilateral) cranial nerve palsy and contralateral hemiplegia, just like the above popular concept.


806.
Case) There is a thrombus..in the brain...it is the posterior cerebral artery. What kind of anopia (eye damage) do you get? What other structures does it supply? (pick it out on x ***)


A) You will see contrlateral hemianopia with macular sparing! It supplies midbrain structures like the THALAMUS, lateral, medial geniculate bodies, and the occipital lobe. (FIND IT ON X ***!)



807.
Q) Think now of occlusions: What foramen connects the Lateral and Third ventricle? Pick it out on x ***...the exact location!


A) Foramen of Monroe


808.
What structure connects the third and fourth ventricles?



A) CEREBRAL AQUEDUCT. Again, pick it out on X ***!


809.
Case: So common, a child's head is swollen. He also has myelomeningocele and syringomyelia. What is the name of the dx. and what is blocked?


A) Commonly, the cerebral aqueduct is blocked... in most cases. Also, this dx is commonly Arnold Chiari syndrome...w/ hydrocephalus.


810.
Q) Here, just understand that the fourth ventricle communicates with the subarachnoid space thru how many ventricles?



A) Three! Name them please. Point to them on X *** please...

© 2003, 2004 ValueMD Inc. All rights reserved.


811.
Q) How exactly do you define communicating hydrocephalus?


A) Here, it is NOT intra ventricular, but is due to CSF reabsorption FAILURE in the subarachnoid space.


812.
Case: Name a common bacterial dx. that causes the communicating hydrocephalus!


A) don't get non communicating confused with communicating. Meningitis has been implicated a lot in communicating hydrocephalus


813.
Q) Name the common nucleus that is lesioned in HUNTINGTON's Disease.


A) Caudate Nucleus


814.
Case: Given a coronal slice of the brain at the optic chiams, pick out the hypophysis, amygdala, and cavernous sinus, and NASOPHARYNX, and Caudate nucleus.


A) Sorry, please review on a X-*** atlas!!


815.
Given a circle of the cell phases, point to the part (M phase, G1, S, G2 phases) where Methotrexate works.


A) S or synthesis phase. Other drugs that work here are 5-FU, cytarabine, 6-mercaptopurine.


816.
Given a circle of the cell phases, point to the part (M phase, G1, S, G2 phases) where TAMOXIFEN works.


A) G1 phase, where RNA and protein synthesis occurs (S phase is where DNA synthesis forms)!


817.
Case: Given a circle of the cell phases, point to the part (M phase, G1, S, G2 phases) where Bleomycin works.


A) G2 phase.


818.
Case: You are doing a Lumbar puncture to test for a case of Lyme disease. Under which vertebra will you draw the fluid?


A) L4


819.
Case: If I gave you a picture of a man with Growth hormone hyperactivity (acromegaly), tell me, which two hormones regulates this hormone?


A) GHRH and SOMATOSTATIN!


820.
Case) Physio question renal: What is the net glomerular filtration pressure?
Bowman's capsule hydrostatic pressure = 10 mm Hg
Osmotic pressure of tubular fluid = 1 mm Hg
Osmotic pressure of plasma = 30 mm Hg
Glomerular hydrostatic pressure = 50 mm Hg


A) Remember: Take forces pushing out minus forces pushing in.
So, OUT PRESSURE FROM GLOMERULUS = 50 + 1 mm Hg MINUS
IN PRESSURE INTO GLOMERULUS = 10 + 30 mm Hg
Therefore, 51 - 40 = 11 mm Hg


821.
Case: A male pt. of yours who is 36 comes in with large bowel cancer. After it is cut out, a few months later the cancer returned with a vengence. A serum decrease of which of the following is responsible for metastasis after removal? (Pick Endostatin or Platlet Derived Growth Factor)



A) HEY I said DECREASE...so Endostatin. This compound SUPPRESSES tumor growth while PDGF stimulates it.


822.
Case: A 25 year old woman becomes paraplegic after after a spinal cord injury at T2. She is suffering from constipation. You advise her to distend her rectum with her finger to stimulate the defectation reflex. What MOA causes this? (Pick either Relaxation Of External Anal sphincter OR Increased peristaltic waves)



A) Increased peristaltic waves is the right ans. The stimulation sends afferent signals that move thru the myenteric plexus and starts peristaltic contractions which sends out the stool.


823.
The famous S curve shifts to the RIGHT during exercise and you do see higher 2,3 diphosphoglycerate which caused this. What is MOA?


A) Because GLYCOLYSIS is reved UP.


824.
True or False: Beta hydroxybutyrate and acetoacetate can be converted to glucose to supply the needs of the brain during a period of starvation.


FALSE! Although these Ketone bodies can supply energy, THEY are derived from ADIPOSE TISSUE and cannot be CONVERTED into glucose! Key concept here!


825.
Many many friendly words are coming to me to clarify my "scary" post on the USMLE Step 1. I wish to put to rest any possible confusion. What I really do not like about the USMLE Step 1 is the apparent variation different test takers face.

For instance, some told me they loved HY Goljian notes/audio and some only found it BARELY useful. Same as QBank . Some thought it helped them SO SO much, and others who felt they got a test full of transgenic mice and cell biology did poorly with QBank (which stresses Pathophysiology).

The point I am making even applies to First Aid. As some of you and others of my students said, DO NOT OVERESTIMATE OR UNDERESTIMATE First Aid. Some said they got like a large percentage of their test covering First Aid, and others said they recalled almost NOTHING in First Aid on their test.

That is why I really feel there is a "luck" element in the Step 1 which I do not particularly like. Long ago, before computers, the tests were all taken on the SAME day, like twice a year for TWO days. There were a lot more short answer specific questions.

But today, because of the computer led variation, you have no idea what version out of an infinite set of possibilites you will receive.

So please remain hopeful. I do not mean to make anyone feel bad or hopeless. YOU MAY GET LUCKY like my friend in Radiology did! You may get a version of the test that addresses your STRONG points. Maybe you worked in an IMMUNO lab and your test is mostly IMMUNO. Or maybe your part time job was with a pathologist, and your test looks a lot like Robbin's Review of Pathology. OR, like one of the previous test takers, your previous career was a CHIROPRACTOR, and your test was filled up with ANATOMY. That DOES happen, but the problem is we all have no control over it. And that is why I think the test is "not perfect". If you failed long time ago, you know that basically everyone in the country taking the test that day also faced similar questions. But TODAY, if you GOT some WEIRDO set of questions (like a series of Radiographs), a block of Molecular Bio or Embryo which you totally did NOT study, and if you failed, that is not exactly fair because you knew SO much say Pharmacology and your test score did not and can not reflect that. Maybe the answer is to make SURE that all the topics are covered in a broader test that encompasses TWO days and more questions....I dunno. Any thoughts on my feeling bad about people struggling?


826.
Given a graph or table regarding systolic vs diastolic time, tell me...are the times equal or not?


A) They are unequal. Diastolic time is 2/3s and Systolic is usually 1/3 of the time.


827.
Describe what happens to a USMLE test taker who is tachycardiac from anxiety...I mean, compare the diastolic vs. systolic filling times as a ratio.

A) KNOW that as your heart races, the diastolic filling time decreases MUCH faster than systole. Crucial.


828.
Case: You have a pt. 41 year old man, who climbs up Mt. Kilamanjaro, way up high! After a week, he is slighly tachypneic with a decrease in arterial PCO2. Will you see increased kidney excretion of protons OR increased kidney excretion of bicarbonate?


A) INCREASED EXCRETION of BICARB! The inital respiratory alkalosis is compensated by metabolic acidosis. This is confusing but YOU NEED TO KNOW IT. The body will thus hold on to protons.


829.
In high altitudes, would you get alveolar hypoxic vasoconstriction or vasodilation?


A) PULMONARY vasoconstriction!


830.
T or F: You need to know the basics of receptors. Is the famous GABA-A receptor a voltage gated CHLORIDE channel?


A) FALSE. Listen I am NOT being picky. It is a LIGAND-GATED CHLORIDE channel.


831.
The famous 5HT-3 receptor is a ligand gated Na+ channel receptor. True or false?



A) TRUE!

valuemd.com

832.
Case: The incredibly famous NMDA receptor is LIGAND gated and NOT voltage gated. (True or false statement?)


A) FALSE! The NMDA receptor is BOTH voltage and ligand gated. It requires BOTH a ligand and voltage/neuron depolarization for activation. Sodium AND calcium will move thru this channel.


833.
What ion is the "plug" for the resting NMDA receptor?


A) It is a magnesium ion.


834.
Case: A newborn baby suffers from lack of oxygen due to asphyxia. Would the baby have a sustained HIGH systemic blood pressure or a sustained HIGH pulmonary pressure? After picking, tell me why?


A) The baby would have sustain high PULMONARY pressure from RIGHT to LEFT shunting from either an open foramen ovale or PDA. Naturally, his systemic organs would all be damaged along with increased risk of DIC.


835.
Case: After delivering a 10 hour baby girl, you notice she produced a bloody meconium stool. What should you do for evaluation? Should you 1) Order an upper GI series test, or 2) Check an Apt test which determines fetal vs. materal blood?


A) 2) You should check if the blood is from the mother or the fetus. If it is from the mother, no further workup is necessary.


836.
Case: A two and a half pound premature baby is brought to your office (this is a newborn nursery clinic you are working in). Her mother asks if her breast milk is good enough. T or F? And if False, what major ion does the premature infant desperately need (ans is not folate)?


A) F... Premature infants need extra doses of calcium, as breast milk will not provide nearly enough for the premature baby.


837.
Case: An infant weighing 4.5 lbs is born at 34 weeks. After delivery, in a few minutes, the baby will do which of the two? (Pick SHIVERING or RAPID BREATHING) And then tell me why?


A) The baby is not going to shiver, but his body temp will decline, and his metabolic acidosis will make him breath faster.


838.
This is some suggestions I gave to some who were SO BORED and SICK of studying....

Love you back. You absolutely have to find any way to KEEP your study schedule intact. The fact that this test is so long and awful subconsciously makes test takers nauseous. I know many who drank themselves silly because it hurt so much to study.

Thus, know that you are NOT alone at all. BUT, it seems you need a change of environment. One student I knew DID go to the library for a change of pace and it seemed to help. Another started studying OUTSIDE in the sun on his apartment complex rooftop overlooking the city. It somehow gave him peace.

Another female student I knew kept changing study places every few hours (coffee shop, bookstore, etc.) to stave off the boredom.

Still another, drank coffee and ate a LOT because it helped him rev up his sympathetic system and thus his depression over studying.

What else? Oh, one guy I knew would rent out a movie, and then reward himself after a full day of studying. He would put the movie on his TV and that would be his motivation.. Let me know if this helps. I think I will put this in the ValueMD Concept Bank.


839.
Q) Does dopamine turn directly into tyrosine or norepinephrine in selective cells?


A) NOREPINEPHRINE. Remember, it goes Tyrosine to DOPA to Dopamine to Norepi to Epi.


840.
Case: DNA can be wrapped tightly because of HISTONES. What TWO amino acids are often found responsible for the tight fitting? They may give you a diagram.


A) Arginine and Lysine. Positively charged, they bind to the neg. phosphate groups on DNA.


841.
Case: Two patients, one with G6PD Deficiency and another with Pyruvate kinase def. How are these two diseases DIFFERENT in CLINICAL presentation from the Thalassemia dxs?


A) Both G6PD and Pyruvate Kinase def. present with INTERMITTENT hemolytic anemias (with normal periods), while the Thalassemias and other anemias are CHRONIC and CONSTANT in clinical presentation. The triggers for dxs. like G6PD are the sulfa drugs, etc.


842.
Q) Many know that the EXTRACELLULAR compartment buffer is Bicarbonate. What about the INTRACELLULAR buffering compartment?


A) It is a PHOSPHATE BUFFERING system.


843.
A forty nine year old male has TYPE II Diabetes for 10 years. He dies suddenly at home. He is a nonsmoker. Which is more likely to have caused his death? (pick either MI, kidney failure, stroke, infection)?


A) MI is the most common cause of death for type II Diabetics!


844.
Case: Sadly, a patient of yours tries to kill himself by swallowing a jar of benzodiazepines with alcohol. Respiratory depression ensues. What will his LABS look like? give in terms of pH, PO2, PCO2?


A) His slow respirations causes respiratory acidosis. Thus, the pH is DOWN, the PO2 is down, and the PCO2 is up.


845.
Case: A female woman working in a dry cleaning facility gets heavy inhalation of carbon tetrachloride. Which organ is most likely to be damaged the MOST? (pick one: heart, bladder, stomach, OR liver)


A) LIVER! recall the P450 system and free radicals generated when it tries to metabolize CCl4


846.
Case: A 71 year male with lymphadenopathy has recurrent infections and weakness. There is a M protein spike. There is BENCE JONES PROTEIN in urine. He has bone pain. BUT, he also has a hard time seeing now, bright eosinophilic plasma cells on bone marrow aspiration, and a cough.(EVERYONE IS THINKING MULTIPLE MYELOMA, but this is another dx.. so DON'T jump ahead.) Dx?


A) These are the symptoms of Waldenstrom Hypergammaglobulinemia...look for the cough, sight dysfunction, and "flame plasma cells".


847.
Case: A 73 year old female presented with a clinical picture and labs (w/ smudge cells) diagnostic of CLL. What are the relative levels of CD5, CD 22, and CD23?


A) Unlike other B cells disorders, CLL has HIGH CD5 and CD23, and low CD22.


848.
A 55 year old man has an ECG done. The QRS intervals are .15 secs with atypical patterns. The second heart sound is SPLIT. What is the LIKELY conduction defect? Is it First degree AV heart block or Mobitz Type I AV block or Mobitz Type II AV block?


A) This picture is diagnostic for "bundle branch block". (QRS interval > .12 secs and S2 split). SO, know that Mobitz II AV block is common here.


849.
Case: You are examining a patient with First Degree AV block. What is the MOA here? Is the PR interval affected?


A) Here, we will see a PROLONGED PR interval (know it on ECG chart) over .22 seconds! The AV node is lesioned, so there is a conduction delay.


850.
Case: You see a male alcoholic patient with signs and symptoms of pancreatic carcinoma. (pain radiating to back, etc.). Which tumor marker helped you make the diagnosis on LABS? (pick either CEA elevated or alpha feto protein elevated)


A) Answer is CEA. Along with COLON cancer, pancreatic cancer has CEA as an active tumor marker.

[Anonymous]

Thank you for saving our times!

Good luck to you!