Exam on 24th Oct. Done with NBME 16 online - 2.5 months ago (244) and UWSA1 2 weeks ago (271). Stressed af about the exam. Is it worth it to take NBME 19 and risk a low score due to the tight curve or should I just do SA2 and NBME 18? Study Nbme 19 using smart web & mobile flashcards created by top students, teachers, and professors. Prep for a quiz or learn for fun! 19 yo man stabbed in abdomen. Denies starting fight and intends to 'get even'. Incarcerated for past 3 yrs for armed robbery but says he was 'set up'. NBME 19 Block 1 answers with explanation ALL ANSWERS ARE CONFIRMED FROM ONLINE NBME 1- f it's marcus gunn pupil,you should know that it's decreased bilateral pupillary constriction when light is directed to affected eye.

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11 year old + warmth and tenderness + mid-diaphyseal lytic lesion + concentric layer of reactive bone (onion like ) >>> Ewing sarcoma

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2- b
it is the mechanism of action of nitroglycerin as it causes release of NO that acts via cGMP
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3- e
gonorrheal infection and other STDs do not require consent in minors so the physician should treat patient without notifying parents
contraception,pregnancy,drug abuse and emergencies do not require consent as well
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4- c

you have to know the definition of confidence interval. The CI = the odds (or likelihood) of finding the true average within a set range. Odds ratio is essentially comparing the odds between cases vs. control for both alcohol consumption and no-alcohol consumption. If one of the answer said, ' There is a 5% chance that the true average is not within the range between 1.8 - 6.6' that would be a legitimate answer

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trauma during mountain hiking + fever + calf swelling and tenderness + crepitus >>> this is a case of gas gangrene which is caused by c.perfringens

c.septicum can also cause gas gangrene so why not it ?

the answer is that c.septicum causes spontaneous gas gangrene with rapid onset and hemorrhagic bullae, BUT it is not associated with trauma (unlike c.perfringens)

in the question,it is mentioned that there was mountain hiking making having trauma more likely and hence c.perfringens is the answer

you should also know that c.septicum can cause colon cancer mostly in presence of IBD&immunosuppresion as risk factors

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myopathy&rhabdomyolysis are common side effects of statins particularly when given with fibrates

myoglobin released from damaged muscle cells may cause acute renal failure

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efficacy is defined as maximal effect regardless of dose (which determines potency)

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the graph shows that pressure in left atrium is rising during systole and there is systolic murmur,this indicates mitral valve incompetence

the only choice that can cause mitral valve incompetence is rupture of chordae tendineae

history of rheumatic valvular disease support diagnosis although it most commonly causes stenosis after many years

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sweet odor when changing diaber + increased isoleucine in urine >>> maple syrup urine disease,in which,degradation of branched amino acids (leucine - isoleucine - valine) is blocked due to ↓ branched-chain 𝞪-ketoacid dehydrogenase

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hyperresonance + absent breath sound >>> pneumothorax

in all other choices ,hyperresonance does not occur

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11- a
dorsal white matter of the upper thoracic spinal cord has only dorsal column tract which carries proprioception and 2 points discrimination -discriminative sensation- (differentiate if one finger is touching you or two fingers at the same time)
pain and temperature are carried my lateral spinothalamic tract
and motor activity are carried by corticospinal tract
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12- e
this patient has decreased bile absorption due to jejunoileal bypass as blie is absorbed from ileum,a decrease in bile absorption by turn will lead to decrease fat and fat soluble vitamins absorption (K,E,D,A) ,hence fecal fat is increased and fat soluble deficiency will develop
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13- a
bcl-2 is antiapoptotic , so when overexpressed , it will decrease cell death
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14- d
history of severe cramping pain in right flank that radiates to groin + pain not releived by position >>> stone
prophylaxis of stone formation is by drinking large amount of water in order not to let solutes concentrate and form stones
although calcium stones are the most common type kidney stones ,decreasing calcium in diet is not helpful as most cases of kidney stones occur in people with normal calcium level (normocalcemia & hypercalciuria) , and calcium absorption is regulated by vit d
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15- d
Chancre: charachterized by mononuclear cell infiltrate dominated by plasma cells with scattered histiocytes; also obliterative endarteritis with thickened small vessels due to proliferation of endothelial cells and fibroblasts
Condyloma lata: resembles condyloma acuminatum, and charachterized by prominent epidermal hyperplasia, more edema, chronic inflammatory infiltrate, but less keratinization, minimal if any koilocytosis

Gummas: have caseous necrosis, chronic inflammatory cell infiltrate, obliterative endarteritis
Healed gummas: become noncontractile scars with arching fibrosis

for more information :

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it is a case of CO poisoning

cherry red skin raises suspicion of either CO or cyanide poisoning

important key to know that headache is the most initial symptom on CO poisoning

in addition to being in a closed cabin in a truck raises suspicion of poisoning with Vehicle exhaust
CO poisoning is treated with 100% O2 + hyperbaric O2
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17- b
it is a case of biliary atresia
in biliary atresia :
- failure to form or early destruction of extrahepatic biliary tree
- leads to biliary obstruction within first three months of life
- normal at birth and then destructed by immune mediated or viral induced
- presents with jaundice (conjugated bilirubin) and progress to cirrhosis
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18- c
the cardiac phonogram shows a holosystolyc murmur
the only choice which causes this finding is mitral regurgitation
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19- c
vomiting associated with cancer chemotherapy is usually treated or prevented with ondansetron as first therapy
metochlopramide is commonly used in diabetic and postsurgery gastroparesis Nbme