NBME Form 31 Incorrects

Question 1

2wk history of pain in R leg just below the knee of 14yr old boy. XR shows large, semi-Ca mass that erodes the medullary canal of the tibia, infiltrates the cortex, and extends into the nearby soft tissues.

Answer 1

osteosarcoma.
predominately affects the LONG bones: tibia, femur
erodes thru cortex givin “sunburst” periosoteal rxn, elevation of periosteum> Codman tri
histology: lesion w/ primitive cells in lace-like meshwork of bone with mitoses; osteoblast-like mesencyhmal cells that make osteoid.
aggressive, poor prognosis.

Question 2

what is the most common primary bone tumor to affect the vertebrae?

Answer 2

osteoblastoma, benign; no response to aspirin.
vertebrae are common MET sites for breast & prostate cancer> look for pain worse in the night/sclerotic lesions

Question 3

MOA of ketoconazole?

Answer 3

inhibition of lanosterol->ergosterol in the fungal cell wall by 14ademethylase.

Question 4

what is the common cause of tinea cruris?

Answer 4

trichophyton rubrum
tinea cruris> “jock itch”, crotch and peritoneum.

Question 5

what is the typical treatment for tinea cruris?

Answer 5

topical azole antifungal> clotrimazole

Question 6

chronic hep C pt, 2wk hx weakness/rash on legs. 2+ edema, pupuric rash over the extremities. C3/C4 decreased. UA dysmorphic RBC, no casts. creatinine inc.

Answer 6

essential mixed cryoglobulinemia> cryoglobulins are IGs that precipitate out of the serum. triad: weakness, arthralgias, palpable purpura.
risk factors: chronic Hep C/B, HIV, malaria, EBV; chronic inflame- SLE, Sjogren; lymphoproliferative multiple myeloma.

causes deposition of immune complexes (HS3) in BV> leukocytoclastic vasculitis> can manifest as purpura, end organ dysfunction= renal failure/nephritic/nephrotic syndromes.

Question 7

49yr old with poorly controlled HTN in ER with SOB. Ran out of meds 5 days ago. BP 240/120, pulse 98, r 32, 86% O2. Loud S4. b/l crackles on lung fields. CXR pulm edema. Diagnosis?

Answer 7

congestive heart failure> presenting as decompensated heart failure.

pathophyis> long-standing, uncontrolled HTN> ventricular hypertrophy> dec compliance, dec filling>diastolic dysfxn.
with a loud S4 (gallop in late diastole), most likely diastolic dysfunction HF. inc atrial P, ventricular hypertrophy, as the LA attempts to overcome stiff/noncompliant LV.

Question 8

echocardiography shows thick LV muscle tissue. what is the underlying condition?

Answer 8

HTN> LV hypertrophy as a result of constant work against the incr afterload> impaired LV relaxation, inc diastolic P> LA enlargement> heart failure over time.

Question 9

mitral stenosis findings on ECG

Answer 9

LA hypertrophy, reduced LV SV
opening snap with diastolic rumble murmur

Question 10

23yr F w/ chronic sinusitis. Needs to drain L maxillary sinus–what is the placement of the cannula?

Answer 10

at middle meatus, at the hiatus semilunaris.
pt has bacterial sinusitis 2/2 viral URI; dull pain aggravated by leaning forward.
complications: orbital cellulitis, cavernous sinus thrombosis, meningitis.

Question 11

the anterior portion of the piriform aperture is commonly opened during what procedure?

Answer 11

functional septoplasty–enhances airflow thru nose
// ant portion of aperture opens into the cartilaginous anterior nasal vestibule> lateral to maxillary bones, nasal septum medial.

Question 12

sphenoethmoidal recess is found at?

Answer 12

the superior aspect of the nasal cavity– superior and posterior to the superior nasal concha» opens into the sphenoid sinus– common pathway for the trasnsphenoidal approach to pit gland

Question 13

what is immediately anterior to the torus tubarius?

Answer 13

opening of the eustachian tube into the nasopharynx» connects posterior nasopharynx to the middle ear» causing acute otitis media.

Question 14

what is immediately inferior to the anterior margin of the superior conchae?

Answer 14

superior nasal meatus–which communicates with the posterior ethmoid cells.

Question 15

44yr M with 2 month history of dry mouth, constipation, inability to have erection, progressive fatigue. neuro exam shows weakness of alot muscles, absence of all stretch reflexes; normal sensation. CXR shows R lung mass. Labs show antibodies directed against PQ calcium channels. Why neuro findings?

Answer 15

impaired Ach release at NMJ, limiting cell depol, proximal muscle weakness» not dec excitation contraction coupling. pt has Lambert-Eaton paraneoplastic syndrome 2/2 small cell lung cancer.

LE= extended use makes better, gradual accumulation of Ach in synapse= better depol. PRESYNAPTIC NMJ. (MG is postsynpatic Ach NMJ)

Question 16

male newborn has multiple features suggestive of Downs syndrome. Chromosomal analysis is ordered. What do you tell the parents?

Answer 16

The newborn has features of Downs, a chromosomal test is ordered» NOT the newborn has some unusual features on exam, and a test has been ordered to help determine diagnosis.
Doc should address objective findings by explaining diff diagnosis and the next steps in simple language in small pieces> honor autonomy w/ relevant information–do not protect patient from distressing news, allow them to process info in small pieces.

Question 17

what are the symptoms of cavernous sinus thrombosis?

Answer 17

i/l orbit pain, sinusitis, proptosis, periorbital edema, impaired eye movement/pupil reactivity.
» CN 3,4,5a,5b,6 transverse the sinus

Question 18

what patients are at risk for developing ophthalmic artery embolism?

Answer 18

carotid/cardiac valvular disease pt> central retinal artery occlusion» acute, painless vision loss and diminished visual acuity, pale fundus (preserved foveal color), afferent pupillary defect.
*****admit to stroke center for emergent eval

Question 19

48yr man w/ 30yr PMH DM1 w/ sudden onset double vision. L eye weakness abduction. What is the development of double vision ?

Answer 19

diabetic mononeuropathy.
microvascular damage commonly affects the abducens n> presents as esotropia, u/l abduction defect, diplopia in horizontal gase, hypotropia. most pts have resolution of symptoms with tx of underlying cause.
**important to rule out stroke, ICP, vasculitis, optic neuropathy,

Question 20

24yr woman with increased ROM in her joints. 6ft tall, 130lb, BMI 18. Pectus excavatum. Cardio exam reveals new diastolic murmur. What is the most likely cause?

Answer 20

aortic insufficiency» pt has Marfan syndrome, impaired collagen synthesis.
subsequently leads to an incr LV EDV» eccentric hypertrophy of the LV, progressive LV systolic dysfxn

Question 21

when would you see a systolic murmur in a Marfan pt?

Answer 21

myxomatous degeneration of mitral value» mitral insufficiency (mitral valve prolapse)» presents with holosystolic murmur.

Question 22

24yr F w/ 3day history of vaginal discharge w/ itching. Currently tx with ciprofloxacin for cystitis. Vaginal area now presents with thick, white discharge. What is the most likely caused organism?

Answer 22

candida albicans> pt has vaginal pruritis, thick white discharge with antibiotic tx> vulvovaginitis from Candida. “cottage cheese” appearance
neg KOH testing, normal vaginal pH, no trichomonads on wet mount
risk factors: those on antibiotics, contraceptives (oral & intrauterine), immunocompromised, DM
tx: antifungals (topical clotimazole, oral fluconazole)

Question 23

N. gonorrhea is gram neg that can present with cervicitis, PID, Fitz-Hugh-Curtis, urethritis, vaginitis. How can you tell diff btw gonorrhea vs. candida?

Answer 23

the discharge»gonorrhea will present with mucopurulent discharge, pruritis, and be generally asymptomatic vs candida is thicker, white discharge.

Question 24

76yr M in ER with inability to urinate. Markedly enlarged prostate, u/s shows large kidneys with dilated calyces. PO2 is 90mmHg. What is the suspected ABG?

Answer 24

pt has BPH> leading to hydronephrosis, obstructive uropathy> leading to volume expansion +RAAS> HTN» metabolic acidosis, non-anion gap via urinary acidification (generally unless uremia or another concomitant anion gap issue). will be compensated w/ resp alk, tachypnea» near normal pH.

Question 25

56yr M w/ 2 month hx bloody cough. CT shows 4cm mass in RUL that's obstructing SVC. Blood returns to heart via?

Answer 25

internal mammaries & intercostal veins. when SVC obstructed, can drain into the IVC via internal mammary v with sup/inf epigastric v. the azygos/hemiazygous v drain posterior intercostal/bronchial v> via lumbar venous system to IVC long thoracic venous communicates with femoral & verterbral v> to IVC. pt will develop venous congestion head/neck/upper extremities= SVC syndrome regardless of collaterals tho

Question 26

what veins are the main venous drainage of the head?

Answer 26

jugular & subclavian v. external jugular v> subclavian>internal jugular>brachiocephalic> L & R merge to make SVC.

Question 27

43yr F w/ 2 mon history of intermittent abdominal pain, esp after fatty meals, localized to RUQ. u/s shows cholelithiasis. MOA of ursodiol?

Answer 27

decreased cholesterol secretion into bile by 40-60%, dec absorb into the gut; ursodiol=ursodeoxycholic acid (generally second line to surgery) pt has all characteristics of cholelithiasis: middle-aged female, RUQ pain after fatty meals. risk factors: obesity, advanced age, estrogen tx, rapid weight loss, Crohn's, 4F's **statins generally have lower gallstone risk; fibrates (inhibit chol 7a hydroxylase) have most risk--> end up having supersaturated cholesterol with inhibited bile acid synthesis.

Question 28

32yr F with intermittent chest pain "not severe, just kinda annoying". Mother died of sudden MI ~50s. Midsystolic click at 5th intercostal space on L midclavicular line. What cardio thing is happening?

Answer 28

mitral valve prolapse> generally asympt, but have palpitations, chest pain, dyspnea. midsystolic click +- late systolic murmur of mitral regurg. more common in females, most common cause is myxomatous degeneration, chorda tendinea rupture, mitral annular disjunction> where the mitral annulus becomes partially detached. ***degeneration results in thickened mitral valve leaflets with accumulation of fibrous & mucoid material>> commonly associated w/ Marfan, PKD, SLE, polyarteritis nodosa.

Question 29

ASD murmur

Answer 29

fixed, split S2 with low grade physiological ejection murmur L>R shunt with abnormal flow of blood from LA to RA> volume overload R heart

Question 30

Bicuspid aortic valve murmur

Answer 30

bicuspid aortic valve> aortic stenosis> crescendo-decrescendo systolic murmur @ R upper sternal border

Question 31

Tricuspid regurg murmur

Answer 31

holosystolic murmur best heard in L lower sternal border>> esp common with severe pulm HTN/infective endocarditis of IV user

Question 32

what is the most common skin cancer?

Answer 32

basal cell carcinoma> originating from basal layer of epidermis, low met potential typically: pink, pearly papules/nodules with rolled borders & central ulceration in sun exposed areas of head/neck. tx: surgical excision removal, Mohs surgery associated w/ mutations in hedgehog pathway of p53...primary risk factor is UV exposure.

Question 33

63yr M with long history of sun exposure develops skin lesion. Lesion is 1cm, dark colored

Answer 33

malignant melanoma, commonly develops from pre-existing nevus or de novo; prognosis is dependent on depth of invasion Asymmetry Borders: irregular Color: varied colors (pic shows brown, light parts) Diameter: >6mm Evolution: rapid evolution> melanoma.

Question 34

what are the subtypes of malignant melanoma?

Answer 34

superficial spreading nodular melanoma lentigo maligna acral lentiginous melanoma

Question 35

what does actinic keratosis look like?

Answer 35

chronic rough, scaly patches. commonly treated with liquid nitrogen, topical 5FU

Question 36

22yr M ER 30mins s/p tonic-clonic seizure began in L leg. 3yr PMH intermittent L arm stiffening, spasms of L thigh. No PMH or FHX of seizures. MRI of brain most likely to show lesion where?

Answer 36

R frontal cortex> pt presenting with L sided focal seizure (those originating from frontal lobe are generally partial/focal seizures). primary motor cortex is in frontal lobe. tx: begin with antiepileptic meds, then surgery as needed. ***frontal cortex also likely to have partial seizures that exhibit secondary generalization (pt here)

Question 37

what lobe is most commonly affected by focal seizure activity?

Answer 37

temporal lobe> typically presenting with complex partial seizures-- aura, motor symptoms (lip-smacking, fidgeting), autonomic dysfxn, confusion.

Question 38

seizures presenting from the parietal lobe commonly present as?

Answer 38

somatosensory seizures> numbness, tingling, warmth, pain. receptive aphasia, dyslexia, lang comprehensive disturbances-- Wernicke at jnct of parietal/temporal lobes.

Question 39

30yr F 18wk gestation. U/s shows intracranial anomalies: single ventricle, small cerebrum, fused thalamus, corpus callosum agenesis. Where did failure originate?

Answer 39

prosencephalon> should've separated into telencephalon (cortial hemi & lateral ventricles) diencephalon (thalamus, hypothalamus). pt has holoprosencephaly. pros- forebrain mes- midbrain rhomb- hindbrain

Question 40

failure of the rhombencephalon leads to what abnormalities?

Answer 40

rhombencephalon> metencephalon & myelencephalon--> brainstem, cerebellum, 4th V> Dandy-Walker is associated here.

Question 41

58yr M with progressive hair loss in past few weeks. Father & grandfather had similar hair. Scalp shows loss of hair in M pattern over frontal hairline. What is the mechanism?

Answer 41

dihydrotestosterone binding to androgen receptors at terminal hair follicles> "male patterned baldness"= androgenic alopecia. testosterone->dihyrotestosterone (more potent) via 5a reductase. hairs transition to finer fairs "miniaturization"

Question 42

2 month M newborn ER with noisy/difficult breathing for 6 hr. Pt has multiple, slender, finger-like excrescences on both vocal cords. What was the maternal infection?

Answer 42

HPV (6/11)> laryngeal papillomatosis, commonly affecting the vocal cords as nodules/growths

Question 43

Manifestations of fetal infection with HSV

Answer 43

tender vesicles that ulcerate & crust, generally at skin, eyes, mouth. systemic manifestations of meningoencephalitis. transmission via placenta or birth canal. ***can also present as more aggressive laryngeal papillomatosis, but stick with HPV 6/11

Question 44

Hepatocytes don't grow in culture well (dedifferentiated), but do grow effectively with coculturing w/ biliary epithelial cells. Compared to when alone, the cocultured cells most likely produce increase amt of what?

Answer 44

urea> heptaocyctes have urea cycle, removing ammonia to urea for kidney excretion. Failure of this process leads to hepatic encephalopathy. **dedifferentiated cells will maintain core metabolic pathways common to most cells--glycolysis, mito resp, but loose metabolic fxn: urea cycle, AA de/transamination, gluconeo, synthesis of proteins/coagulation factors

Question 45

Coculturing hepatocytes would be expected to have increased metabolism/consumption of?

Answer 45

alanine> more coversion of alanine to glutamate for gluconeo fructose> absorb via GLUT2, metabolize more fructose via fructolysis, only happening in liver

Question 46

54yr w/ severe HTN suddenly collapses and LOC while having telephone argument. Pt has pinpoint pupils and decorticate posturing. CT shows what most likely hemorrhage?

Answer 46

intraparenchymal> most commonly with uncontrolled HTN, occurring in putamen/thalamus/pons/cerebellum. **pinpoint pupils, decorticate posture (lesion above red nucleus= disinhibition, flexor posturing) localizes to thalamic hemorrhage.

Question 47

epidural hematoma presents

Answer 47

CT lens shaped, bi-convex, hyperdense collections abutting the inner table of the calvarium= trauma to MMA. initial LOC, lucid interval, progressive decline to death

Question 48

subarachnoid hemmorhage presents

Answer 48

CT hyperdense blood products in cerebral sulci and basal cisterns> aneurysmal rupture of artery in subarach space/traumatic injury acute, severe headache, photophobia, stupor/coma "worst headache of life"

Question 49

subdural hemmorhage presents

Answer 49

CT crescent shaped collection abutting the internal surface of the calvarium, not bound by suture lines= bridging veins problems headache, vomiting, meningism, UMN findings

Question 50

30yr F w/ 2 day hx of double vision and eye deviation. 24hrs s/p MVA. L ptosis, L eye "down & out". What happens when light shined into R eye?

Answer 50

R pupil constriction, L pupil no change> deficit in CN 3 (oculomotor) CN3 holds efferent branch of light response (interneurons at Edinger-Westphal nucleus); susceptible to injury while crossing the post comm artery to ciliary ganglion>, controlling iris sphincter. **KEY: all injuries to efferent are i/l, so pt damages L CN3 injury= L efferent injury= L pupil arc unable to respond to direct & consensual light response (no ability to constrict at all)

Question 51

Explain Marcus Gunn pupillary phenomenon

Answer 51

relative AFFERENT pupillary defect (rAPD) "swinging flashlight", u/l or asymmetric response to light stimulation> generally with optic neuropathy, glaucoma, or retinal pathology. dilation of one pupil as light moves quickly=abnormal response

Question 52

what is the most common setting for b/l non-reactive pupils?

Answer 52

elderly patients with pupillary scarring via uveitis, or patients on opioid analgesics.

Question 53

what muscles does CN3 innervate

Answer 53

levator palpebrae superioris superior/medial/inf rectus inferior oblique *also the efferent arc of pupil light response

Question 54

Clinical study of sickle cell allele, frequency of AA is 1/20, in Hispanics 1/200. Which genetic mechanism originally produced this stratification of allele frequency?

Answer 54

heterozygote advantage> continuous presence of the allele at high freq, in two genetically separate populations suggests heterozyg provides advantage that allows recess allel to persist.

Question 55

what is assortative mating

Answer 55

non-random type mating where individuals select partners based on phenotypes that are similar/dissimilar to own>> skews population toward more homozygous than would happen purely by chance

Question 56

what is balanced polymorphism

Answer 56

presence of multiple phenotypes vartations of trait w/in population heterozygous advantage is the specific mechanism by which the balanced polymorph of sickle cell trait is maintained

Question 57

what is founder effect

Answer 57

type of genetic drift that reduces genetic diversity when a subgroup of pop becomes genetically separated from rest of population; significantly alters freq of alleles

Question 58

what is gene flow

Answer 58

introduction of new alleles into the population due to migration from genetically separate population> if rate of flow is high enough, the two populations will merge into single genetic population

Question 59

Drug X is given IV. Produces HR increase, AV conduction increase, no chnage in ventricular contraction. It is most similar to what class (alpha +-, beta+-, muscarinic +-)?

Answer 59

muscarinic antagonist (parasympathetic)> M2 works on SA/AV node> dec HR, atrial contraction

Question 60

what are the differences between sympathetic vs parasympathetic effects on heart characteristics?

Answer 60

sympathetic-- will change pressures, HR, atrial & ventricular contraction parasympathetic-- HR, atrial contractility only (SA/AV node)

Question 61

6yr M fever & cellulitis on R hand. 2cm, red, macular lesion. Tx with nafcillin begins. Next 24hrs pt develops 102.2F, cultures grow MRSA. Production of what caused the resistance to methicillin?

Answer 61

new penicillin binding protein

Question 62

Serratia, Klebsiella, Pseudomonas have demonstrated B-lactam resistance via?

Answer 62

mutations in genes coding for porins in cell envelope>>allows for passive transport of hydrophilic molecules thru the outer membrane of gram - organisms primarily

Question 63

what classic organism has resistance to antibiotics via altered antibiotic efflux pump

Answer 63

EColi> altered efflux pump lowers concentration of antibiotics

Question 64

Increasing the production of folate causes resistance to TMX via

Answer 64

increased production B9 via DHF reductase increases synthesis of purines needed for cell growth/division, ultimately leading to resistance to TMX. *TMX targets DHF reductase to decrease folate synthesis

Question 65

what is the main mechanism of resistance to B lactam antibiotics (penicillin, ampicillin) in gram - bacteria

Answer 65

penicillinase & B lactamases> these genes encoding enzymes can be transferred on plasmids btw bacteria>inactivate B-lactam antibiotics **commonly why we give B-lactamase inhibitors with some of those classes as well

Question 66

62yr F with 25yr PMH DM2. 165cm, 79kg, BMI 29. Doc recommends influenza virus vaccine at this visit. Admin of vaccine is most likely to produce antibodies against what viral structure protein?

Answer 66

hemagglutinin> a membrane fusion protein binding sialic acid receptor on host cells allowing for viral entry. prevents subsequent infection of host cells **vaccination contains multiple strains of killed virus due to random mutations in hemagglutinin protein= antigenic drift

Question 67

MOA of oseltamivir

Answer 67

anti-influenza med, targets neuraminidase, enzyme on viral surface that enables release of influ virus from host cell by cleaving sialic acid from glycoproteins

Question 68

what are M1 matrix protein, M2 ion channel, nucleoprotein

Answer 68

M1- influenza virus matrix protein that coats the inner viral envelope. M2- influ virus ion channel on viral envelope of influenza A. nucleoprotein- structural protein binds to viral RNA

Question 69

52yr M lives in Indiana w/ 1 month hx fever, nonproductive cough, works construction. 101.1F, crackles heard over all lung fields. CXR shows b/l interstitial infiltrates. Transbronchial biopsy shows oval yeast w/in macrophages. The most likely causal organism in the patient has a cell wall with?

Answer 69

glucans> pt has Histoplasma capsulatum pulmonary histoplasmosis characterized by fever, malaise, cough, with develop calcified nodules in mediastinal/hilar lymphadenopathy. transmission: inhalation of fungal spores endemic to Mississippi/Ohio river valley

Question 70

what is the virulence of H.capsulatum

Answer 70

dependent on growth inside non-activated macrophages, protecting fungal cells from detection & elimination. risk factors: exposure to bird/bat droppings

Question 71

Histoplasma on culture grows via septate mycelia--with what components in cell wall

Answer 71

glucans (mostly), chitin, glycoproteins

Question 72

Polyglutamic acid is the organic polymer synthesized by what bacteria

Answer 72

Bacillus species>>expressed in cell capsule as virulence factor allowing for immune system evasion

Question 73

14yr M w/ small lump in L breast 2 months ago. 2.5cm, mildly tender, rubbery mass under L areola. Sexual maturity is 2 for genital/pubic hair. Remainder of exam shows no abnormalities. Most likely diagnosis?

Answer 73

physiologic gynecomastia> increased amt of glandular breast tissue in males, and common in puberty. Commonly present 12-14yrs w/ tender mass behind the nipple, typically self-resolving. gynecomastia is small, rubbery, mobile, well-circumscribed.

Question 74

Sebaceous cysts commonly contain squamous epithelium, located?

Answer 74

commonly on trunk, face> well-circumscribed lesions with central punctum, generally painless unless infected.

Question 75

interventions for puberty gynecomastia

Answer 75

puberty gynecomastia with disruption of androgens/estrogens; increased levels of estrogen with conversion of androstenedione/T to estrone/estradiol. tx: aromatase inhibitors, liposuction if continued annoyance

Question 76

41yr M acute onset abd pain caused by calculus at R ureterovesical junction. Pain is most likely to radiate where on the R?

Answer 76

R groin> sensory fibers that intervate ureters enter spinal cord at T12-L2> pain referral is common to groin via dermatomes **pain at costovertebral angle is suggestive of pyelonephritis: fever, flank pain, tenderness--> nephrolithiasis pain can refer here is stone obstructs kidney w/ hydronephrosis

Question 77

32yr M w/ 6wk hx persistent pain, swelling in R arm beginning after fall on hike. 2 months ago he had hike in Andes Mountains. He splited arm w/ stick, food supply was limited to saltine crackers, PB, processed cheese. Xray today shows R arm with poorly formed callus, nonunion of fracture ends. Most likely pt had dec fxn of what protein?

Answer 77

prolyl-4-hydroxylase>> facilitates the hydroxylation of proline & lysine in collagen synthesis/tissue repair w/ Vit C. Vit C is essential, found in fruits/veggies--pt's diet indicates deficiency

Question 78

scurvy presents as

Answer 78

BV fragility (easy bruising, petechiae, perifollicular hemorrhage) impaired wound/bone healing disordered "kinky" hair growth

Question 79

Investigator studying T-cell clone recognizes a peptide from the hemagglutinin glycoprotein of influenza virus. This clone most likely recognizes a peptide that was combined with HLA_DR2 in which cellular component?

Answer 79

endosomes>cytoplasmic organelles mainly composed of microtubules/vesicles that traffic/sort endocytosed material (vaccines, live virus). HLA-DR2 (MHCII) synthesized in rER trafficked to golgi, then late endosomes.

Question 80

Peptides combined with MHC1 are located

Answer 80

ER (lmao so close)

Question 81

8yr boy 6month hx of difficulty reading, impulsive behavior. IQ is 203, reading/math, 101/97. Screening shows clinicially significant levels of inattention, impulsivity, hyperactivity. Mood disorder screening is normal. The most appropriate tx for this pt is durg effecting what neurotransmitter?

Answer 81

norepi> ADHD w/