NBME Exam Questions & Answers | 100% Correct
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25 yo F at 27 weeks w/ severe contractions x6 hours, vaginal spotting, contractions every 2-3 mins w/
FHR 130 and no decels, cervic 1-2 cm and 70% effaced, GBS is positive. next step? - IM
beclamethasone THEN ...
25 yo F at 27 weeks w/ severe contractions x6 hours, vaginal spotting, contractions every 2-3 mins w/
FHR 130 and no decels, cervic 1-2 cm and 70% effaced, GBS is positive. next step? - ✔✔IM
beclamethasone THEN later can give penicillin
man w/ 15 yr hx of difficult relaxing hands after tightly gripping objects or shaking hands, difficulty
releasing after gripping w/ hands. dx? - ✔✔myotonic muscular dystrophy
pt unable to see out of R eye since awakening 2 hrs ago. visual acuity 20/200 in R eye and 20/20 in L. R
pupil poorly reactive to light. where is site of lesion? - ✔✔R optic nerve
6 mo old w/ poor feeding, labored breathing, to and fro murmur in 2nd L itnercostal space, loud S2,
bounding peripheral pulses, widened pulse pressure. dx? - ✔✔patent ductus arteriosus
recurrent lymph node infxns w/ staph a in a kid. what is dx and mechanism? - ✔✔chronic granulomatous
dz --> impaired phagocytic oxidative metabolism
pt hyperkalemic bc missed 2 dialysis appointments. EKG w/ peaked t waves. next step? - ✔✔IV calcium
gluconate --> THEN can give insulin but this works within minutes
hyaline casts vs WBC casts? - ✔✔-WBC casts: interstitial nephritis and pyelonephritis
-hyaline casts: AKI
4 yo M in MVC, RR 32 w/ grunting and restractions, hypoxic on ABG, CXR 4 hrs later shows diffuse
infiltrates on R side. dx? - ✔✔pulmonary contusion
asymptomatic 57 yo M smoker, bruit in RUQ, no masses, BUN 23, Cr 1.4. what is cause of bruit? -
✔✔accumulation of lipids in arterial wall --> renal artery stenosis
,52 yo F w/ decreased libido, underwent TAH and bilateral salpingo-oophorectomy for leiomyomata uteri
and menorrhagia. on hormone replacement + estrogen since sx. exam w/ moist, rugated vagina. what is
cause? - ✔✔decreased androgens/testosterone --> due to oophoreectomy = decreased androstenedione
and DHEA = aka hypergonadotropic hypogonadism ant pituitary works ovaries don't
67 yo F w/ afib on warfarin, INR 6 so meds stopped, next day she had abdominal pain and vomiting x24
hours, Hgb 13 --> 7.8. cause? - ✔✔intramural hematoma of proximal small bowel --> rare complication
of warfarin
67 yo M w/ 1 hours of vertigo, nausea, imbalance, small R pupil, mild R ptosis, nystagmus, weakness of R
palate, sensation to pinprick is decreased over R face and L extremities + incoordination of finger to nose
and heel-shin. where is occlusion? - ✔✔R vertebral
77 yo F w/ cramping abdominal pain and distention w/ n/v. no hx of abdominal sx. afebrile, tachy.
distended abdomen w/ mild diffuse tenderness. BS are high pitched. x-ray of abdomen shows air fluid
levels in SB and liver but no gas in colon or free air. dx? - ✔✔gallstone ileus --> air in billiary tree/liver
even though all other signs sound like SBO
18 mo old has not used L arm since he fell while walking & holding hands w/ sister. he is holding LUE at
side w/ forearm pronated. no tenderness of LLE, restricted movement of elbow. next step? - ✔✔passive
hypersupination of forearm --> nurse maid elbow aka radial head dislocation (can also hyperpronate)
asthmatic teen w/ asthma attack, she hast not been taking her meds. what is best way to get her to be
compliant - ✔✔negotiate a contract regarding med compliance
5 mo old w/ persistent wheezing since birth, well-nourished, wheezing w/ extension of neck. what is
cause? - ✔✔compression of airway by vascular ring --> malformation of aorta so wraps around trachea,
improves w/ neck extension --> sx
*largyngomalacia improves in prone position not extension*
heavy cigarette smoker w/ hiccups. Na+ 120. CXR w/ R hilar mass. next step? - ✔✔fluid restriction -->
SIADH from small cell lung CA
, female w/ herberden's nodes, generalized weakness x2 weeks. BUN 41 and Cr 4. what is cause? -
✔✔ATN --> from chronic NSAIDs
32 yo F brought to ED after MVC, agitated, SOB, tachy, RR30, hypotensive, breath sounds absent on R, L
sounds normal, CXR w/ opacification of R hemithorax. cause? - ✔✔hemothorax
IVDU w/ papilledema, LP w/ high proteins, low glucose, 200 cells. dx? - ✔✔fungal meningitis -->
cryptococcal --> prolly has AIDS
52 yo F w/ difficulty sleeping through the night since son graduated HS 2 months ago and found out he is
gay, obsesses about this, feels SOB and tachy during these episodes, worried about her son, is on leave
from work. dx? - ✔✔adjustment disorder w/ anxiety
*NOT PANIC DISORDER*
16 yo M episode of left arm shaking that lasted 3 mins, fever, disoriented, LP w/ 120 WBC and 300 RBC,
low glucose, high protein. cause? - ✔✔viral infxn --> likely HSV encephalitis --> RBCs in CSF without a
history of trauma is highly suggestive of HSV encephalitis
pt w/ n/v for 48 hours what will his labs look like? - ✔✔hypokalemia, hypochloremia
44 yo G4P4 w/ 9 mo loss of small amounts of urine will running, pelvic exam shows 2nd degree
cystourethrocele. what is cause of her incontinence? - ✔✔stress incontinence from prolapsed bladder
23 yo F one day s/p SVD starts having small amounts of urine loss, had an episiotomy, voiding 50-75 mL
at at time, post void residual = 300 mL. cause? - ✔✔overflow incontinence
what drug can cause neutropenia? - ✔✔carbamezipine
87 yo F w/ dementia, presents w/ flu like symptoms, cough x1 week, fever, crackles in R lung base, CXR
w/ infiltrate at right L base, what is cause of pts PNA? - ✔✔decreased gag reflex --> aspiration PNA
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