of 29
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Block 1
____________
1-5 EABEA
6-10 BDABE
11-15 ABADG
16-20 AADBB
21-25 FDCED
26-30 FEDEA
31-35 GCBCA
36-40 BCBCA
41-45 FECAE
46-50 DABDE
Block 2
___________
1-5 AABBE
6-10 CEBAE
11-15 DDDBA
16-20 DECED
21-25 BBDDB
26-30 ADEDC
31-35 DDEEE
36-40 EEDAA
41-45 BDCDB
46-50 CDCBB
Block 3
8/19/2019 NBME 7 key
2/29
___________
1-5 ACDEC
6-10 AEBDC
11-15 ACCBB
16-20 AEDBB
21-25 CBAAD
26-30 EBACA
31-35 ECBAD
36-40 DACAE
41-45 CABAB
46-50 DEDAE
Block 4
___________
1-5 AAADA
6-10 BEBDC
11-15 BABAE
16-20 CCFAA
21-25 EGBBA
26-30 DDBCC
31-35 AECFC
36-40 DCDDD
41-45 BBABB
46-50 CCADC
8/19/2019 NBME 7 key
3/29
NBME 7 BLOCK 1 answ!s
1" E" #os$%as&a&'n
- (&a&'n )c!ass LDL
- N'ac'n 'nc!ass *DL
- F'+!a&s )c!ass &!'a,lc!')s
*MG-coA !)$c&as 'n.'+'&o!s a! /o! c&'% o! +!'n,'n, &. LDL &ono!/al l%l""""
. 'n.'+'& c.ols&!ol !c$!so!M%alona&
(E"""#.a+)o/ol's's
!%!s'+l .',. l%l l'%! $nc&'on &s&
Lo%as&a&'n!a%as&a&'ns'/%as&a&'nA&o!%as&a&'n#o so%as&a&'n"""""""""""as&a&'n
2" A" B!onc.ocons&!'c&'on
a!l$cas&Mon&l$cas&"""""L$ko&!'n !c&o! +lock!s !%n&
+!onc.ocons&!'c&'on
3" B" 8Do o$ know w.a& k'n)s o oo)s a! .',. 'n so)'$/9:
4" E" ;!'/o!)'al ,!/ cll /',!a&'on<
&. &$/o! s.ows a .a.a=a!) a!!an,/n& o so/a&'c &'ss$s !!sn&'n,
)!'%a&'%s o c&o"""/so"" an) n)o)!/"""""'& 's a c.a!ac&!'s&'c o ,!/clls"
8/19/2019 NBME 7 key
4/29
!a&o/a 's )!'%a&'% o !'/'&'% s&!ak w.'c. 'n%ol%s !ocss o ,!/ cll/',!a&'on"
- Fo! n$/+! 4""".'s 's a cas o (ac!ococc,al &!a&o/a"">""""
- (ac!ococc,al &!a&o/a 's on o &. ?&!a,ona)al ,!/ cll &$/o!s """
- .s &$/o!s can + o$n) anw.! on &. /')l'n a!&'c$la!l &.
!&!o!'&on$/ &. an&!'o! /)'as&'n$/ &. sac!ococc? an) &. 'nal
,lan)" O&.!
lss co//on s'&s 'ncl$) &. o!+'& s$!aslla! a!a ala& &.!o')
s$+/an)'+$la! !,'on
an&!'o! a+)o/'nal wall s&o/ac. l'%! %a,'na an) !os&a&" . class'c
&.o! s$,,s&s
&.a& ,!/ cll &$/o!s @GCs> 'n &.s a!as a! )!'%) !o/ local&!anso!/a&'on o
!'/o!)'al ,!/ clls /'slac) )$!'n, /+!o,ns's"""w.'c. /ans )c&
'n !'/o!)'al
,!/ cll /',!a&'on
.&&
8/19/2019 NBME 7 key
5/29
!'ccl'c an&')!ssan& o%!)os""""!'ccl'cs .a% a na!!ow &.!a$&'c
'n)? '"" &. &.!a$&'c )os 's clos &o &. &o?'c )os"
. !'.!al a$&ono/'c n!%o$s ss&/ cn&!al n!%o$s ss&/ an) &.
.a!& a! &. /a'n ss&/s &.a& a! ac&) ollow'n, o%!)os"
n'&'al o! /'l) s/&o/s &'call )%lo w'&.'n 2 .o$!s an) 'ncl$)
&ac.ca!)'a )!ows'nss a )! /o$&. na$sa an) %o/'&'n, $!'na!!&n&'on con$s'on a,'&a&'on an) .a)ac."
Mo! s%! co/l'ca&'ons 'ncl$) .o&ns'on ca!)'ac !.&./ )'s&$!+ancs.all$c'na&'ons an) s'=$!s" Elc&!oca!)'o,!a/ @ECG> a+no!/al'&'s a!
!$n& an) a w') %a!'& o ca!)'ac )s!.&./'as can occ$! &. /os&co//on +'n, s'n$s &ac.ca!)'a an) 'n&!a%n&!'c$la! con)$c&'on )la!s$l&'n, 'n !olon,a&'on o &. #( co/l? an) &. ;# 'n&!%als"
('=$!s ca!)'ac )s!.&./'as an) ana a! &. /os& '/o!&an& l'
&.!a&n'n, co/l'ca&'ons"
6" B" Class M*C /olc$l &') loa)'n,
;!oss'onal A;Cs a! %! Hc'n& a& 'n&!nal'='n, an&',n '&.! +
.a,oc&os's" . ac')'c co/a!&/n&s o /ac!o.a,s a! also !sons'+lo! &. ),!a)a&'on o 'n,s&) /'c!o-o!,an's/s> o! + !c&o!-/)'a&)
n)oc&os's an) &.n )'sla'n, a !a,/n& o &. an&',n +o$n) &o a class
M*C /olc$l on &.'! //+!an" . cll !co,n'=s an) 'n&!ac&s w'&.
&. an&',n-class M*C /olc$l co/l? on &. //+!an o &. an&',n-!sn&'n, cll"
7" D" ;!$%a& ca!+o?las
- &. !o+l/ 's &.a& s. 's .o,lc/'a an) &.n w'&. an 'n$s'on w
,l$cos '& .ls"
- (o &. !o+l/ 's /ak'n, ,l$cos.nc o$ n) !$%a& ca!+o?lasn=/ o! ,l$cono,ns's"
8/19/2019 NBME 7 key
6/29
A )c'nc o !$%a& ca!+o?las can ca$s lac&'c ac')os's as a !s$l& olac&a& +$'l) $" No!/all ?css !$%a& 's s.$n&) 'n&o ,l$cono,ns's
%'a con%!s'on o !$%a& 'n&o o?aloac&a& +$& +ca$s o &. n=/
)c'nc ?css !$%a& 's con%!&) 'n&o lac&a& 'ns&a)"
As a k !ol o ,l$cono,ns's 's 'n &. /a'n&nanc o +loo) s$,a!
)c'nc o !$%a& ca!+o?las can also la) &o .o,lc/'a
;!$%a& ca!+o?las 's a /'&oc.on)!'a n=/ !$'!'n, +'o&'n" & 's
ac&'%a&) + ac&lCoA@ !o/ +&a- o?')a&'on" . !o)$c& o?aloac&a&@OAA>a c'&!'c ac') ccl 'n&!/)'a& canno& la% &. /'&oc.on)!'a +$& 's !)$c)
&o /ala& &.a& can la% %'a a Mala& s.$I" n &. c&olas/ /ala& 's
!)$c) &o @OAA>"
;!$%a& ca!+o?las )c'nc 's an 'n.!'&) )'so!)! &.a& ca$ss lac&'c
ac') an) o&.! o&n&'all &o?'c co/o$n)s &o acc$/$la& 'n &. +loo)" *',.
l%ls o &.s s$+s&ancs can )a/a, &. +o)Js o!,ans an) &'ss$s
a!&'c$la!l 'n &. n!%o$s ss&/" ;!$%a& ca!+o?las )c'nc 's a !a!con)'&'on w'&. an s&'/a&) 'nc')nc o 1 'n 250000 +'!&.s wo!l)w')" .'s
)'so!)! aa!s &o + /$c. /o! co//on 'n so/ Al,onk'an n)'an &!'+s
'n as&!n Cana)a"
.&&
8/19/2019 NBME 7 key
7/29
no!/al> &o &. lsoso/" '&.o$& !o! $nc&'on'n, o N-ac&l,l$cosa/'n-1-.os.o&!ans!as a +$'l) $ o s$+s&ancs occ$!s w.n n=/s a!
$na+l &o &!a%l 'ns') o &. lsoso/
- Cll D'sas< @ncl$s'on cll )'sas>" n.!'&) lsoso/al s&o!a, )'so!)!a'l$! o a))'&'on &o /annos 6 .os.a& &o lsoso/ !o&'ns@ n=/ a!
sc!&) o$&s') &. cll 'ns&a) o +'n, &a!,&) &o &. lsos/" #s$l& 'n
coa!s ac'al $&$! clo$)) co!nas !s&!'c&) o'n /o%/n& an) .',.
la/a l%ls o lsoso/s" O&n a&al c.'l).oo)"
.&&
/$scls o &. +o)"
. .all/a!k o /as&.n'a ,!a%'s 's /$scl waknss &.a& 'nc!ass )$!'n,
!'o)s o ac&'%'& an) '/!o%s a&! !'o)s o !s&" C!&a'n /$scls s$c. as
&.os &.a& con&!ol an) l') /o%/n& ac'al ?!ss'on c.w'n,&alk'n, an) swallow'n, a! o&n +$& no& alwas 'n%ol%) 'n &. )'so!)!"
n /as&.n'a ,!a%'s an&'+o)'s +lock al&! o! )s&!o &. !c&o!s o!
ac&lc.ol'n a& &. n$!o/$sc$la! $nc&'on w.'c. !%n&s &. /$scl
con&!ac&'on !o/ occ$!!'n,
11" A" Dc!as
L$!ol')< an&a,on's&< $lsa&'l< &!a&s !os&a&""/an'n, )c!as L*F(*"
.&&
8/19/2019 NBME 7 key
8/29
12" B" Cn&!o/!
a" #ana$)s .no/nonC#E( sn)!o/an&'-cn&!o/! an&'+o)
C!s& (n)!o/< Calc'ca&'ons #ana$)Js .no/non Eso.a,al
)s/o&'l'& (cl!o)ac&l an) lan,'c&as'a" L'/'&) sk'n 'n%ol%/n&
o&n conn) &o n,!s an) ac" Mo! +n',n cl'n'cal co$!s" Assoc'a&)w'&. An&'cn&!o/! An&'+o)"
13" A" Ac$& 'na//a&'on
Ac$& anc!a&'&'s
14" C" D" ;a!%o%'!$s B1
wo o &. so$!cs sa &.a& &. answ! 's D" ;a!%o%'!$s B 1 @/a+ +ca$s
'& .as &o )o w'&. s'ckl cll an/'a .nc &. ./o,lo+'n P ./a&oc!'& 's low
+$& &.n wo$l)n& o$ s s'ckl cll s.a 'ns&a)>" ;l$s a!%o%'!$s ac&#BC !c$!so!s @!&'c$loc&s> so 'sn& &. !& c& k'n)a no!/al @s'nc &.'s 's
&. cas o$ know &.a& &. +on /a!!ow 's wo!k'n, an) '& 's co/nsa&'on"E" ;n$/ocs&'s '!o%c' @o!/!l ;"ca!'n''> 's $s$all sn 'n a)$l&s"
AD(
;a!%o%'!$s B1 's a ca$s o c.!on'c an/'a 'n 'n)'%')$als w.o .a% AD(" &
's !$n&l o%!look)" !a&/n& w'&. !&.!oo&'n o! 'n&!a%no$s'//$no,lo+$l'n .a% +n .l$l 'n so/ a&'n&s" . a!%o%'!$s 'nc&'on
/a &!',,! an 'na//a&o! !ac&'on 'n AD( a&'n&s w.o .a% $s& +,$n
an&'!&!o%'!al &.!a"14Q"
.&&
8/19/2019 NBME 7 key
9/29
.n assoc'a&) w'&. &. l$n, '& o&n ca$ss c&o'c !o)$c&'on o
a!a&.!o') .o!/on-!la&) !o&'n @;*!;> !s$l&'n, 'n .!calc/'a"
($a/o$s-cll ca!c'no/a o &. l$n, 's /o! co//on 'n /n &.an 'n wo/n"
& 's closl co!!la&) w'&. a .'s&o! o &o+acco s/ok'n, /o! so &.an /os&
o&.! &s o l$n, ca!c'no/a" & /os& o&n a!'ss cn&!all 'n la!,! +!onc.'
an) w.'l '& o&n /&as&as'=s &o loco!,'onal l/. no)s @a!&'c$la!l &..'la! no)s> a!l 'n '&s co$!s '& ,n!all )'ss/'na&s o$&s') &. &.o!a?
so/w.a& la&! &.an o&.! /ao! &s" La!, &$/o!s /a $n)!,o cn&!al
nc!os's !s$l&'n, 'n ca%'&a&'on" A s$a/o$s-cll ca!c'no/a 's o&n !c))o! a!s + s$a/o$s-cll /&alas'a o! )slas'a 'n &. !s'!a&o!
'&.l'$/ o &. +!onc.' w.'c. la&! &!anso!/s &o ca!c'no/a 'n s'&$" n
ca!c'no/a 'n s'&$ a&'cal clls /a + ')n&') + c&olo,'c s/a! &s& o
s$&$/ +!onc.oal%ola! la%a, o! sa/ls !o/ n)o+!onc.'al +!$s.'n,s"*ow%! s$a/o$s-cll ca!c'no/a 'n s'&$ 's as/&o/a&'c an) $n)&c&a+l
on R-!a !a)'o,!a.s" E%n&$all '& +co/s s/&o/a&'c $s$all w.n &.&$/o! /ass +,'ns &o o+s&!$c& &. l$/n o a /ao! +!onc.$s o&n
!o)$c'n, )'s&al a&lc&as's an) 'nc&'on" ('/$l&ano$sl &. ls'on 'n%a)s
'n&o &. s$!!o$n)'n, $l/ona! s$+s&anc" On .'s&oa&.olo, &.s &$/o!s
!an, !o/ wll-)'!n&'a&) s.ow'n, k!a&'n a!ls an) cll $nc&'ons &oanalas&'c w'&. onl /'n'/al !s')$al s$a/o$s-cll a&$!s"
.&&
8/19/2019 NBME 7 key
10/29
Bon scans a! $s$l 'n )&!/'n'n, &. ?&n& an) ac&'%'& o &. con)'&'on" a +on scan s$,,s&s ;a,&Js )'sas &. ac&) +on@s> s.o$l) + R-
!a) &o con!/ &. )'a,nos's
. a&.o,ns's o ;a,&Js )'sas 's )sc!'+) 'n 3 s&a,s w.'c. a!<
'" Os&oclas&'c ac&'%'&
''" M'?) os&oclas&'c-os&o+las&'c ac&'%'&
'''" E?.a$s&'% @+$!n& o$&> s&a,
n'&'all &.! 's a /a!k) 'nc!as 'n &. !a& o +on !so!&'on a& local'=)
a!as ca$s) + la!, an) n$/!o$s os&oclas&s" .s local'=) a!as oos&ols's a! sn !a)'olo,'call as an a)%anc'n, l&'c w), 'n lon, +ons
o! os&oo!os's c'!c$/sc!'&a 'n &. sk$ll" . os&ols's 's ollow) + a
co/nsa&o! 'nc!as 'n +on o!/a&'on 'n)$c) + os&o+las&s !c!$'&) &o
&. a!a" .'s 's assoc'a&) w'&. accl!a&) )os'&'on o la/lla! +on 'n a)'so!,an'=) as.'on" .'s 'n&ns cll$la! ac&'%'& !o)$cs a c.ao&'c 'c&$!
o &!a+c$la! +on @S/osa'cS a&&!n> !a&.! &.an &. no!/al l'na! la/lla!
a&&!n" . !so!+) +on 's !lac) an) &. /a!!ow sacs a! ll) +an ?css o +!o$s connc&'% &'ss$ w'&. a /a!k) 'nc!as 'n +loo)
%ssls ca$s'n, &. +on &o +co/ .!%asc$la!" . +on
.!cll$la!'& /a &.n )'/'n's. la%'n, a )ns Sa,&'c +onS also
known as +$!n)-o$& ;a,&Js )'sas"
17" A" D'sc$ss co/o!& ca! w'&. &. a&'n&s w'
all c.o'cs ?c& A a! a!&'c'al !oc)$!s &.a& !olon, .'s l'"
1" D" (c.'s&oc&s
No!/al lac&a& ).)!o,nas 's 25-0 TL&.'s a&'n& .as 1000TL"")n'&l ;
8/19/2019 NBME 7 key
11/29
;< .!o/+o&'c .!o/+oc&on'a ;$!$!a< 's a !a! )'so!)! o &. +loo)-coa,$la&'on ss&/ ca$s'n, ?&ns'% /'c!osco'c &.!o/+oss &o o!/ 'n
s/all +loo) %ssls &.!o$,.o$& &. +o) @&.!o/+o&'c /'c!oan,'oa&.>" Mos&
cass o ; a!'s !o/ 'n.'+'&'on o &. n=/ ADAM(13 a/&allo!o&as !sons'+l o! cla%'n, la!, /$l&'/!s o %on 'll+!an)
ac&o! @%F> 'n&o s/all! $n'&s" A !a!! o!/ o ; call) Ts.aw-(c.Ul/ansn)!o/ 's ,n&'call 'n.!'&) as a )s$nc&'on o ADAM(13" la!, %F/$l&'/!s !s's& &.! 's &n)nc o! 'nc!as) coa,$la&'on"
.&&"
20" B" (/ll
Ola&o! CN 's &. onl CN w'&.o$& &.ala/'c !la &o co!&?" F$nc&'on< (/ll @
FA 413>
21" F" nc!as) %ol$/ o )'s&!'+$&'on
22" D" ;n$/o&.o!a?
;n$/o&.o!a? 's )n) as &. !snc o a'! o! ,as 'n &. l$!al ca%'&
&.a& 's 'n &. o&n&'al sac +&wn &. %'sc!al an) a!'&al l$!a o &.
http://en.wikipedia.org/wiki/Thrombo...openic_purpurahttp://en.wikipedia.org/wiki/Thrombo...openic_purpura
8/19/2019 NBME 7 key
12/29
l$n," . !s$l& 's collas o &. l$n, on &. ac&) s')" A'! can n&! &.'n&!al$!al sac &.!o$,. a co//$n'ca&'on !o/ &. c.s& wall @' &!a$/a>
o! &.!o$,. &. l$n, a!nc./a ac!oss &. %'sc!al l$!a"
;!'/a! son&ano$s n$/o&.o!a? @;(;> occ$!s 'n ol w'&.o$&$n)!l'n, l$n, )'sas an) 'n &. a+snc o an 'nc'&'n, %n& " n o&.!
wo!)s a'! 's !sn& 'n &. 'n&!al$!al sac w'&.o$& !c)'n, &!a$/a an)
w'&.o$& $n)!l'n, cl'n'cal o! !a)'olo,'c %')nc o l$n, )'sas"
#'sks ac&o!s o! !'/a! son&ano$s n$/o&.o!a? @;(;> 'ncl$) &.ollow'n,<
W(/ok'n,
Wall &.'n s&a&$! 'n a .al&. !son
WMa!an sn)!o/
W;!,nanc
WFa/'l'al n$/o&.o!a?
Bl+s an) +$lla @so/&'/s call) /.s/a&o$sl'k c.an,s o! ELCs> a!
!la&) &o &. occ$!!nc o !'/a! son&ano$s n$/o&.o!a?"
(con)a! son&ano$s n$/o&.o!a? @((;> occ$!s 'n ol w'&. a w')
%a!'& o a!nc./al l$n, )'sass &.a& 's &.s 'n)'%')$als .a%$n)!l'n, $l/ona! s&!$c&$!al a&.olo, @s &. '/a, +low>" A'! n&!s
&. l$!al sac %'a )'s&n)) )a/a,) o! co/!o/'s) al%ol'" ;a&'n&s
/a !sn& w'&. /o! s!'o$s cl'n'cal s/&o/s an) s$la )$ &oco/o!+') con)'&'ons"
D'sass an) con)'&'ons assoc'a&) w'&. scon)a! son&ano$s
n$/o&.o!a? 'ncl$) &. ollow'n,<
WC.!on'c o+s&!$c&'% l$n, )'sas @CO;D> o! /.s/a< nc!as)$l/ona! !ss$! )$ &o co$,.'n, w'&. a +!onc.'al l$, o /$c$s o!
8/19/2019 NBME 7 key
13/29
.l,/ +!onc.'al l$, /a la a !ol"
WAs&./a
W*$/an '//$no)c'nc %'!$sac$'!) '//$no)c'nc sn)!o/
@*XAD(> w'&. ;C; 'nc&'on
WNc!o&'='n, n$/on'a
W$+!c$los's
W(a!co')os's
WCs&'c +!os's
WB!onc.o,n'c ca!c'no/a o! /&as&a&'c /al',nanc
W)'oa&.'c $l/ona! +!os's
Wn.ala&'onal an) 'n&!a%no$s )!$, $s @, /a!'$ana coca'n>Q
Wn&!s&'&'al l$n, )'sass assoc'a&) w'&. connc&'% &'ss$ )'sass
WL/.an,'ol'o/o/a&os's
WLan,!.ans cll .'s&'oc&os's
W(%! ac$& !s'!a&o! sn)!o/ @(A#(>< A !o!&) 1"7Y o (A#(
a&'n&s )%lo) son&ano$s n$/o&.o!a?"
W.o!ac'c n)o/&!'os's an) ca&a/n'al n$/o&.o!a?
WColla,n %asc$la! )'sas 'ncl$)'n, Ma!an sn)!o/
23" C" Ganc'clo%'!
Ganc'clo%'! 's an an&'%'!al /)'ca&'on $s) &o &!a& o! !%n&c&o/,alo%'!$s @CMX> 'nc&'ons
& 's !s& .os.o!la&) &o a )o?,$anos'n &!'.os.a& @)G;> analo,$"
.'s co/&'&'%l 'n.'+'&s &. 'nco!o!a&'on o )G; + %'!al DNAol/!as !s$l&'n, 'n &. &!/'na&'on o lon,a&'on o %'!al DNA"
A)%!s c&s
8/19/2019 NBME 7 key
14/29
Ganc'clo%'! 's co//onl assoc'a&) w'&. a !an, o s!'o$s .a/a&olo,'cala)%!s c&s" ,!an$loc&on'a n$&!on'a ana/'a &.!o/+oc&on'a
%! na$sa %o/'&'n, )ss'a )'a!!.oa 'nc!as) s!$/ c!a&'n'n
an) +loo) $!a concn&!a&'ons
o?'c'&<
Ganc'clo%'! 's cons')!) a o&n&'al .$/an ca!c'no,n &!a&o,n an)
/$&a,n" & 's also cons')!) l'kl &o ca$s 'n.'+'&'on o s!/a&o,ns's"
.$s '& 's $s) $)'c'o$sl an) .an)l) as a c&o&o?'c )!$, 'n &. cl'n'cals&&'n,
24" E" M'&!al !,$!,'&a&'on
*oloss&ol'c /$!/$! 's +s& .a!) a& &. a? 'n &. l& la&!al )c$+'&$s
os'&'on""""M'&!al #,$!,'&a&'on "
M$!/$!<
Blow'n, .oloss&ol'c /$!/$!
*a!) +s& a& &. a?
#a)'a&'on &o &. a?'lla an) 'n!'o! ), o l& sca$la"
;oss'+l assoc'a&) n)'n,s<
(2< w') .s'olo,'c sl'&&'n,
(3
.&&
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8/19/2019 NBME 7 key
15/29
- &. ca!)'ac ccl w.! + co!ona! a!&!'s )l'%! o?,n &o &./oca!)'$/ 's )$!'n, )'as&ol""""""""w.&.! '& 's ss&ol'c o! )'as&ol'c"""""&.'s 's
/ ass$/&'on"
- no /a&&! ' &. !son 's a& !s& o! )o'n, ?!c's &. co!ona! +loo) ow
's alwas /o! )$!'n, )'as&ol" al&.o$,. &. )$!a&'on o ow 's ,!a&s&
)$!'n, !s& as oos &o ?!c's w.n &. .a!& !a& 's as&! an) &.$s)'as&ol 's o lss )$!a&'on"
Co!ona! +loo) ow occ$!s /os&l )$!'n, )'as&ol +ca$s )$!'n, ss&ol
&. +loo) %ssls w'&.'n &. /oca!)'$/ a! co/!ss)" nc!as) .a!&
!a&s w.'c. !)$c &. &'/ o! )'as&ol ll'n, can !)$c &. /oca!)'al+loo) s$l an) ca$s 'sc./'a"
Dna/'c ?!c's 'nc!ass co!ona! +loo) ow 'n !oo!&'on &o &. .a!&!a& w'&. ak %al$s )$!'n, /a?'/al ?!c's &'call &.! &o % &'/s&. !s&'n, l%l "
26" F" ($!ac&an&
(%!l !/a&$! 'nan&s /a .a% $n)!)%lo) l$n,s +ca$s &.
a! no& & !o)$c'n, &.'! own s$!ac&an&" .'s can la) )'!c&l &o
!s'!a&o! )'s&!ss sn)!o/ also call) .al'n //+!an )'sas 'n &.nona&"
o &! &o !)$c &. !'sk o &.'s o$&co/ !,nan& /o&.!s w'&. &.!a&n)
!/a&$! )l'%! !'o! &o 34 wks a! o&n a)/'n's&!) a& las& onco$!s o ,l$coco!&'co')s a s&!o') &.a& c!osss &. lacn&al +a!!'! an)
s&'/$la&s &. !o)$c&'on o s$!ac&an& 'n &. l$n,s o &. &$s"
27" E" nc!as B-.)!o?+$&!a& 'nc!as os/al'& 'nc!as an'on ,a
- Cas o )'a+&'c k&oac')os's""".',. ,l$cos """.',. k&ons
- B&a.)!o? +$&!a& an) ac&oac&a& +o&. 'nc!as"""""
- Os/ola!'& [2 (!$/ Na\s!$/ ,l$cos 1\BTN2" """so ' $ 'nc!as
8/19/2019 NBME 7 key
16/29
,l$cos $ 'nc!as
las/a os/ola!'&
- An'on Ga [ (!$/ Na - @s!$/ C.lo!') \ (!$/ *CO3>"""'n &. cas o
)'a+&'c K&oac')os's
- an'ons o ac') @ac&oac&a& an) +&a .)!o?+$&!a&> !lac *CO3
""".nc w onl s$+&!ac& C.lo!') !o/ &. (!$/ Na """&.a& /aks &. an'on
,a &o 'nc!as""""
n DKA
]+&a-*)!o?+$&!'c ac') 's a k&on +o)""""'nc
]D$ &o loss o wa&!""""""'nc" s!$/ os/olal'&"
]. an'on ,a 's &. )'!nc 'n &. /as$!) ca&'ons an) &. /as$!)an'ons 'n s!$/ las/a o! $!'n" . /a,n'&$) o &.'s )'!nc @'""
S,aS> 'n &. s!$/ 's o&n calc$la&) 'n /)'c'n w.n a&&/&'n, &o
')n&' &. ca$s o /&a+ol'c ac')os's"
onl Na\ Cl^ an) *CO3^ @\- K> a! $s) w.n calc$la&'n, &. an'on ,a""".al&. a)$l&s 's -12 /EL
@ Na\Q > ^ @ Cl^Q\*CO3^Q >
a $s$l /n/on'c &o !//+! &. .',. an'on ,a 's MTD;LE( @/&.anol
$!/'a )'a+&'c k&oac')os's !oln ,lcol 'son'a=') lac&'c ac')os's&.ln ,lcol sal'cla&s>"
2" D" ;s$)o/onas a!$,'nosa
& 's a G!a/-n,a&'% a!o+'c !o)-s.a) +ac&!'$/ w'&. $n'ola! /o&'l'&
an) o?')as os'&'%
8/19/2019 NBME 7 key
17/29
;" a!$,'nosa sc!&s a %a!'& o ',/n&s 'ncl$)'n, ocan'n @+l$-,!n>
Bca$s '& &.!'%s on /os& s$!acs &.'s +ac&!'$/ 's also o$n) on an) 'n/)'cal $'/n& 'ncl$)'n, ca&.&!s ca$s'n, c!oss-'nc&'ons 'n .os'&als
an) cl'n'cs" & 's '/l'ca&) 'n .o&-&$+ !as."
2" E" M'&!al %al% !olas
Ma!an sn)!o/ can la) &o /'&!al %al% !olas @MX;>
30" A" nc!as ./o,lo+'n F 'nc!as */o,lo+'n A2< ./o,lo+'n A !a&'o
'nc!as !&'c$loc& co$n&
- ;a&'n& .as +&a &.alass/'a
o No!/al a)$l& ./o,lo+'n 's al.a 2 +&a 2 an) al.a 2 ,a//a 2
o nc!as *+A2 @3"5Y>
W Vo$ co/a! &. !a&'o o A)$l& 2 w'&. A)$l& 1
W A)$l& 2 's no!/al .nc a)$l& 2 .as a .',.! no!/al a)$l& ./o,lo+'n
&.an A)$l& 1
o Bo&. /ao! P /'no! [ 'nc!as *+F @al.a 2 ,a//a 2>
W A)$l& 1 no!/all .as al.a 2 +&a 2
W A)$l& 2 no!/all .as al.a 2 )l&a 2
W n +&a &.alass/'a o$ c.an, +&a 2 'n a)$l& 1 w'&. *+F @al.a 2
,a//a 2>
W (o now &. a)$l& 1 .as al.a 2 *+Faka al.a 2 ,a//a 2
W *nc o$ s an 'nc!as 'n *+F
o #&'c$l&s 's no!/al&o 'nc!as +ca$s &.! 's no&.'n, w!on, w'&. &.+on /a!!ow so &.!o! '& )osn& &. !&'c$loc&s"
o /+!on'c ./o,lo+'n< 2= 2
o &!ans'&'on ./o,lo+'n< 2= 2
o &al ./o,lo+'n< 2al.a 2
8/19/2019 NBME 7 key
18/29
o a)$l& ./o,lo+'n *+A1< 2 al.a 2 +&a
o a)$l& 2< 2 al.a 2 )l&a
B&a &.alas/'a< !%aln& 'n /)'&!!ana o$la&'on"
Dc&< o'n& /$&a&'on 'n sl'c'n, s'&s an) !o/o&! s$ncs
B&a &.alas/'a /'no! @.&!o=,o&>
1" +&a c.a'n 'n $n!o)$c)
2" $s$all asn&o/&o/a&'c
3" D? con!/) + 'nc!as *+A2 @ 3"5Y>
B&a &.alas/'a /ao!< @*o/o=,o&>
1" +&a c.a'n 's a+sn&- s%! an/'a !$'!'n, +loo) &!ans$s'on @2`
./oc.!o/a&os's>
2" Ma!!ow ?ans'on @ c!w c$& on sk$ll ?-!a>- skl&al )!o/'&'s c.'/$nkac's
Bo&. /ao! an) /'no! - 'nc!as *+ F @FA a, 343>"
31" G" B2 a)!n!,'c a,on's&
B&a 2 a)!n!,'c a,on's&< B!onc.o)'la&'on @!la? +!onc.'al s/oo&. /$cls>
32" C" .!o')-s&'/$la&'n, .o!/on
(*< .!o')-s&'/$la&'n, .o!/on @also known as (* o! &.!o&!o'n> 's a&') .o!/on sn&.s'=) an) sc!&) + &.!o&!o clls 'n &. an&!'o!
'&$'&a! ,lan) w.'c. !,$la&s &. n)oc!'n $nc&'on o &. &.!o') ,lan)" (* 's &. 1s& s& 'n %al$a&'on o &.!o') $nc&'on"
33" B" A)noca!c'no/a o &. n)o/&!'$/
8/19/2019 NBME 7 key
19/29
A)noca!c'no/a o &. n)o/&!'$/<
Ca!c'no/a n)o/&!'al 's &. Mos& co//on ,ncolo,'c /al',nanc" ak
occ$!!nc a& 55-65 a! o a," Cl'n'call !sn&s w'&. %a,'nal +l)'n," 'call !oc)) + n)o/&!'al .!las'a" #'sk ac&o!s 'ncl$)
!olon,) $s o s&!o,n w'&.o$& !o,s&'ns o+s'& )'a+&s
.!&ns'on n$ll'a!'& an) la& /noa$s" nc!as /o/&!'al 'n%as'on)c!as !o,nos's" @FA a, 47>
34" C" Glo+$s all')$s
;a!k'nson )'sas
($!,! an) ) +!a'n s&'/$la&'on
;lac/n& o an lc&!o) 'n&o &. +!a'n" . .a) 's s&a+'l'=) 'n a !a/ o!s&!o&ac&'c s$!,!" !a&'n, /o&o! s/&o/s w'&. s$!,! was onc a
co//on !ac&'c +$& s'nc &. )'sco%! o l%o)oa &. n$/+! o
o!a&'ons )cl'n)" (&$)'s 'n &. as& w )ca)s .a% l) &o ,!a&
'/!o%/n&s 'n s$!,'cal &c.n'$s so &.a& s$!,! 's a,a'n +'n, $s) 'nol w'&. a)%anc) ;D o! w.o/ )!$, &.!a 's no lon,! s$Hc'n&"35Q
($!,! o! ;D can + )'%')) 'n &wo /a'n ,!o$s< ls'onal an) ) +!a'n
s&'/$la&'on @DB(>" a!,& a!as o! DB( o! ls'ons 'ncl$) &. &.ala/$s &.,lo+$s all')$s o! &. s$+&.ala/'c n$cl$s"35Q D +!a'n s&'/$la&'on @DB(>
's &. /os& co//onl $s) s$!,'cal &!a&/n&" & 'n%ol%s &. '/lan&a&'on o
a /)'cal )%'c call) a +!a'n ac/ak! w.'c. sn)s lc&!'cal '/$lss &osc'c a!&s o &. +!a'n" DB( 's !co//n)) o! ol w.o .a% ;D w.o
s$! !o/ /o&o! $c&$a&'ons an) &!/o! 'na)$a&l con&!oll) +
/)'ca&'on o! &o &.os w.o a! 'n&ol!an& &o /)'ca&'on as lon, as &. )o
no& .a% s%! n$!osc.'a&!'c !o+l/s"2Q O&.! lss co//on s$!,'cal&.!a's 'n%ol% &. o!/a&'on o ls'ons 'n sc'c s$+co!&'cal a!as @a
&c.n'$ known as all')o&o/ 'n &. cas o &. ls'on +'n, !o)$c) 'n
&. ,lo+$s all')$s>"35Q
35" A" D +$la! @!onal>
;ED< !onal %!s'on )o!s'?'on
D F'+$la! n!%< aknss 'n%!s'on Loss ?&ns'on o &. )','&s loss
)o!s'?'on @ oo& )!o> snso! loss on an&!o la&!al l, an) )o!so o &.
8/19/2019 NBME 7 key
20/29
oo& !s& w+ sac" @Kalan ana&o/ a, 25 an) 25>
36" B" ;lacn&a acc!&
;lac&a acc!&a< An 'n%as'on o &. /o/&!'$/ w.'c. )os no& n&!a& &.
n&'! &.'cknss o &. /$scl" .'s o!/ o &. con)'&'on acco$n&s o! a!o$n)
75Y o all cass"
;lacn&a !cc!&a< . wo!s& o!/ o &. con)'&'on 's w.n &. lacn&a
n&!a&s &. n&'! /o/&!'$/ &o &. $&!'n s!osa @'n%a)s &.!o$,.
n&'! $&!'n wall>" .'s %a!'an& can la) &o &. lacn&a a&&ac.'n, &o o&.!o!,ans s$c. as &. !c&$/ o! +la))!1
37" C" l$/
C!o.n D'sas< Also known as !,'onal n&!'&'s 's an 'na//a&o! )'sas
o &. 'n&s&'ns &.a& /a ac& an a!& o &. ,as&!o'n&s&'nal &!ac& !o//o$&. &o an$s ca$s'n, a w') %a!'& o s/&o/s" & !'/a!'l ca$ss
a+)o/'nal a'n )'a!!.a @w.'c. /a + +loo) ' 'na//a&'on 's a& '&s
wo!s&> %o/'&'n, o! w',.& loss1Q2Q3Q +$& /a also ca$s co/l'ca&'ons
o$&s') &. ,as&!o'n&s&'nal &!ac& s$c. as sk'n !as.s a!&.!'&'s 'na//a&'ono &. &'!)nss an) lack o concn&!a&'on"1Q
C!o.nJs )'sas 's &.o$,.& &o + an a$&o'//$n )'sas 'n w.'c. &. +o)Js
'//$n ss&/ a&&acks &. ,as&!o'n&s&'nal &!ac& ca$s'n, 'na//a&'on '& 'sclass') as a & o 'na//a&o! +owl )'sas" .! 's %')nc o a
,n&'c l'nk &o C!o.nJs )'sas $&&'n, 'n)'%')$als w'&. s'+l'n,s aI'c&) w'&.
&. )'sas a& .',.! !'sk"4Q & 's &.o$,.& &o .a% a la!, n%'!on/n&alco/onn& as %')nc) + a .',.! 'nc')nc 'n ws&!n 'n)$s&!'al'=)
na&'ons co/a!) &o o&.! a!&s o &. wo!l)" Mals an) /als a! $all
ac&)" (/ok!s a! &wo &'/s /o! l'kl &o )%lo C!o.nJs )'sas &.an"
.&&
8/19/2019 NBME 7 key
21/29
M'c!osco'c /o!.olo,< Noncasa&'n, ,!an$lo/asan) l/.o')
3" B" 0"1
os'&'% !)'c&'% %al$ ;os'&'% @;;X>< ; @;\F;>
;;X[ 70@70\300>[ 0"1 'n &.'s cas a!o?" 0"1
3" C" M/+!ano$s n.!oa&.
M/+!ano$s Glo/!$lon.!'&'s< LM -)'$s ca'lla! an) GBM &.'ckn'n,"
EM S s'k an) )o/S aa!anc w'&. s$+'&.l'al )os'&s" F - ,!an$la!"
Ca$s) + )!$,s @ n'c'lla/'n Gol) N(AD>" Mos& co//on ca$s o a)$l&n.!o&'c sn)!o/"
. closl !la&) &!/s //+!ano$s n.!oa&.1Q an) //+!ano$s,lo/!$loa&.2Q +o&. !! &o a s'/'la! cons&lla&'on +$& w'&.o$& &.
ass$/&'on o 'na//a&'on"
(o/ a&'n&s /a !sn& as n.!o&'c sn)!o/ w'&. !o&'n$!'a )/aw'&. o! w'&.o$& !nal a'l$!" O&.!s /a + as/&o/a&'c an) /a + 'ck)
$ on sc!n'n, o! $!'nals's as .a%'n, !o&'n$!'a" A )n'&'% )'a,nos's o
//+!ano$s n.!oa&. !$'!s a k')n +'os"
40" A" Esc&as @34-/&.ln)'o?/&.a/.&a/'n>
n&o?'ca&'on o! A/.&a/'n< ;sc.o/o&o! a,'&a&'on '/a'!) $),/n&
$'lla! )'la&'on .!&ns'on &ac.ca!)'a $.o!'a !olon,)
wak$lnss san) a&&n&'on ca!)'ac a!!&./'a )l$s'ons .all$c'na&'ons%!" @FA 44>
8/19/2019 NBME 7 key
22/29
A/.&a/'n< Blocks o n$!o&!ans/'&! $&ak a& &. !sna&'c n!%
&!/'nal
41" F" !onc.an&!'c +$!sa
- !oc.an&!'c +$!s'&'s 's c.a!ac&!'=) + a'n$l 'na//a&'on o &. +$!sa
loca&) $s& s$!c'al &o &. ,!a&! &!oc.an&! o &. /$!" ;a&'n&s
&'call co/la'n o la&!al .' a'n al&.o$,. &. .' o'n& '&sl 's no&'n%ol%)" . a'n /a !a)'a& )own &. la&!al asc& o &. &.',."
- . &!/ ,!a&! &!oc.an&!'c a'n sn)!o/ @G;(> 's now +'n, co//onls$+s&'&$&) o! &!oc.an&!'c +$!s'&'s +ca$s &. 'na//a&o! &'olo, o &.
a'n 's +'n, !$&) + c$!!n& !sa!c. $s'n, $l&!asono,!a.'c /a,n&'c!sonanc '/a,'n, @M#> +as) an) .'s&olo,'c %')nc"
- Fl?'on o! an&%!s'on @140b>< 'l'osoas @w'&. soas /ao! !o/ %!&+!al
col$/n> &nso! asc'a la&a c&'n$s a))$c&o! lon,$s a))$c&o! +!%'s an)
,!ac'l's" .',. /$scls ac&'n, as .' ?o!s< !c&$s /o!'s an) sa!&o!'$s"
42" E" R-l'nk) !css'%
D$c.nn /$sc$la! )s&!o. @DMD> 's a !css'% R-l'nk)" . )'so!)! 's
ca$s) + a /$&a&'on 'n &. )s&!o.'n ,n loca&) 'n .$/ans on &. Rc.!o/oso/ @R21>" . )s&!o.'n ,n co)s o! &. !o&'n )s&!o.'n
an '/o!&an& s&!$c&$!al co/onn& w'&.'n /$scl &'ss$"
43" C" M)'al colla&!al l',a/n&
M)'al colla&!al l',a/n&S known as &. &'+'al colla&!al l',a/n& &oo"MCL
s&!a'ns an) &a!s a! a'!l co//on 'n A/!'can oo&+all" Mos&l &. cn&!an) &. ,$a!)s a! ons w.o ,& &.'s 'n$! )$ &o &. ,!' &!n) on &.'!
cla&s"
An MCL 'n$! can + %! a'n$l an) 's ca$s) + a %al,$s s&!ss &o asl',.&l +n& kn o&n w.n lan)'n, +n)'n, o! on .',. '/ac&" Dn)'n,
8/19/2019 NBME 7 key
23/29
on &. ,!a) o &. 'n$! &. lows& ,!a) @,!a) 1> can &ak +&wn 2 an)10 wks o! &. 'n$! &o $ll .al" #co%! &'/s o! ,!a)s 2 an) 3 a!
)'Hc$l& &o !)'c& +ca$s o &. a/o$n& o )a/a, )on can &ak wks &o
s%!al /on&.s" & 's )'Hc$l& &o al !ss$! on &. 'n$!) l, o! a& las& aw )as"
44" A" . a&&!'+$&) &. )'!nc 'n s$ccss !a&s &o c.anc alon
n o!)! o! '& &o + s&a,'s&'cal s',n'canc o$ n) &. ; %al$ &o + 0"05
aka 5Y
B$& s'nc &. ; %al$ .! 's 0"3 aka 70Y""'& 's onl )$ &o c.anc"
. ; %al$ o! a s&$) s.o$l) + lss &.an 0"05"
.'s %al$ /ans &.a& w.n w !o!/ a s&$) &. 5Y o &. &'/ &.
o+s!%a&'ons a! !'& P 5 Y o &. &'/ &. o+s!%a&'on a! )$ &o c.ancalon"
n &.'s $s&'on &. %al$ o ; 's 0"3 w.'c. /ans &.a& &. !o+a+'l'& &.a&&.s o+s!%a&'ons a! )$ &o c.anc alon 's 30Y w.'c. 's no& a s&a&'s&'callacc&a+l n$/+!"
45" E" (&" o.ns wo!&
(& o.nJs wo!& .as +n s.own &o ca$s /$l&'l )!$, 'n&!ac&'ons &.!o$,.
'n)$c&'on o &. c&oc.!o/ ;450 n=/ CV;3A4 +$& also CV;2C" .'s
!s$l&s 'n &. 'nc!as) /&a+ol's/ o &.os )!$,s !s$l&'n, 'n )c!as)concn&!a&'on an) cl'n'cal c&"
E?a/ls o )!$,s ca$s'n, cl'n'call-s',n'can& 'n&!ac&'ons w'&. (& o.nJswo!&
Class D!$,s
an&'!&!o%'!als non-n$clos') !%!s &!ansc!'&as 'n.'+'&o!s !o&as
8/19/2019 NBME 7 key
24/29
'n.'+'&o!s
+n=o)'a='ns al!a=ola/ /')a=ola/
.o!/onal con&!ac&'on co/+'n) o!al con&!ac&'%s
'//$nos$!ssan&s calc'n$!'n 'n.'+'&o!s c'closo!'n &ac!ol'/$s
o&.!s )',o?'n /&.a)on o/!a=ol .no+a!+'&ol &.o.ll'n
wa!a!'n l%o)oa s$+o?on !'no&can
46" D" nc!as) os/ola!'& 'n &. &$+$la! l$/n @$!'n>
o &. +o .as DM & 1
o 'n & 1 o$ .a% .',. ,l$cos no 'ns$l'n
o .',. ,l$cos w'll !a+so!+ all o &. wa&! 'n&o &. clls &.'s $ll wa&!awa !o/ &. &$+$l @$!'n> an) o$ ,& .!&on'c $!'n
.&& assoc'a&) w'&. DM"
http://en.wikipedia.org/wiki/Diabetic_ketoacidosishttp://en.wikipedia.org/wiki/Diabetic_ketoacidosis
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o$ )onJ& wan& &. )ono! l/.oc&s &o !ol'!a& a& a .',.! !a& &.an &.,$Js own"""
.&&"
http://books.google.com/books?id=EJX......ion&f=falsehttp://books.google.com/books?id=EJX......ion&f=false
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;a&.o,ns's o GE#D"""!ans'n& !la?a&'on o LE( an) nc&'% so.a,alcla!anc o
!$? /a&!'al @+'l ac') an) ,as&!'c $'c>""".nc &. a/o$n& o ac') &.a& 'ssc!&) + &.
s&o/ac. )osn& .a% an s',n'can& c& """also w.&.! &.! 's * lo!' o!no& .as no
s',n'canc """as wll as w.&.! &. s&o/ac. 's a&!o.'c o! no& """
*nc ,o o! /&alas'a o &. so.a,al '&.l'$/ @,'%n &. /on&..'s&o! >
Ba!!&&Js so.a,$s 's a con)'&'on 'n w.'c. &. no!/al s$a/o$s '&.l'$/o &. so.a,$s .as +n !lac) + an a+no!/al !) col$/na! '&.l'$/call) sc'al'=) 'n&s&'nal /&alas'a" (c'al'=) 'n&s&'nal /&alas'a 's
!) l'k no!/al s&o/ac. &'ss$ +$& )os no& look l'k s&o/ac. &'ss$ $n)!
&. /'c!osco"
50" E" $!ol'&.'as's
- ac')'c low !o&'n 'n &. $') /an'n, &.a& &. @no!/al !o&'n 's 1"02>
+loo) 4\ @lo&s o ./ols'sso &.'nk #BC cas&> ,l$cos 's n,a&'% 's '& 's
no& +ac&!'a +c +ac&!'a &aks $ ,l$cos +'l'!$+'n 's n,a&'% so '& 's no& &.l'%! !o+l/ l$koc& s&!as n,a&'% so '& can& + E" Col'
o B" No)$la! !os&a&'c .!las'a 's no& &. answ! +ca$s . 's &oo o$
an) . )osn& alkal'n .os.&as 'nc!as
o C" #CC 's no& '& +ca$s #CC 's c.!on'c&.'s ,$ .as ac$&
o D" (c.'s&o/oas's's a wo!/""so o$ s.o$l) s a !sn& o oso.'lan)
l$s &.'s a&'n& ,l$cos 's n,a&'%" F
T!ol'&.'as's 's &. con)'&'on w.! $!'na! calc$l' a! o!/) 'n &. $!'na!
&!ac&"
Mos& co//on k')n s&ons"""Calc'$/ O?ala&Calc'$/ .os.a&o!
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+o&."""#a)'oa$
O?ala& c!s&al""!s$l& !o/E&.ln ,lcol
(co$n) /os& co//on""""A//on'$/ Ma,ns'$/
.os.a&""(&!$%'&""""ca$s) + 'ncc&'on w'&. T!as-os'&'% +$,s"""""""can
o!/ s&a,.o!n calc$l'
T!'c ac')""""assoc'a&) w'&. .!$!'c/'a""""""""!a)'ol$cn&
Cs&'n"""scon)a! &o Cs&'n$!'a""*?o,onal s.a"""""""""a'n&l
!a)'oa$"""&!a& w'&. alkal'=a&'on
n so/ cass k')n s&ons ass o$& o &. +o) w'&.o$& !o)$c'n, ans/&o/s" Mos& k')n s&ons .ow%! )o ca$s so/ s/&o/s" .
/os& co//on s/&o/ !o/ k')n s&ons 's a'n" . a'n !o/ k')n
s&ons 's a !s$l& o &. s&on ,&&'n, s&$ck on '&s wa o$&"
%! an) c.'lls acco/an an o &.s s/&o/s an 'nc&'on /a +!sn& an) /)'cal a&&n&'on 's n)) soon! !a&.! &.an la&"
La+o!a&o! s&'n,<
La+o!a&o! &s&'n, 'ncl$)s $!'nals's &o )&c& &. !snc o +loo)
@./a&$!'a> an) +ac&!'a @+ac&!'$!'a> 'n &. $!'n"
O&.! &s&s 'ncl$) +loo) &s&s o! c!a&'n'n @&o %al$a& k')n $nc&'on>BTN an) lc&!ol&s &o )&c& ).)!a&'on calc'$/ &o )&c&
.!a!a&.!o')'s/ an) a co/l& +loo) co$n& &o )&c& 'nc&'on"
R-!as< A s&an)a!) ?-!a o &. k')n $!&! an) +la))! /a + a)$a&
as a !s& s& o! ')n&''n, /an s&ons s'nc /os& a! %'s'+l on ?-!a"
Tl&!aso$n)< .'s &s& $ss .',. !$nc so$n) wa%s &o !o)$c 'c&$!s"
Tl&!aso$n)s can )&c& a )'la&) k')n an) $!&! ca$s) + a s&on lo),)
'n &. $!&!" Tl&!aso$n) .ow%! canno& !l'a+l )&c& all s&ons sc'alls&ons loca&) o$&s') &. k')n" & 's &. !!!) '/a,'n, /&.o) o!
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k')n s&on a&'n&s w.o a! !,nan&"
X; @n&!a%no$s ;lo,!a/>< Fo! an X; a sc'al ) 's 'nc&) 'n&o &.
a&'n&Js %'ns" . ) collc&s 'n &. $!'na! ss&/ an) !o)$cs a w.'&
s.a)ow w.n an ?-!a 's &akn" . ) allows &o !c'sl loca& &. s&onan) &o )&!/'n &. con)'&'on o &. k')ns an) $!&!s" Mos& k')n
s&ons can + !c'sl loca&) $s'n, &.'s !oc)$!"
C (can @Co/$&!'=) o/o,!a.>< .'s &s& $ss a scann! an) a
co/$&! &o c!a& '/a,s o &. $!'na! ss&/" A C scan )on &o look o!k')n s&ons )os no& $s con&!as& /a&!'al" & 's &. /os& co//on '/a,'n,
&s& $s) &o)a &o %al$a& a oss'+l k')n s&on a&&ack"
