NBME COMPLETE QUESTIONS AND
ANSWERS
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? - CORRECT ANSWER-IM beclamethasone THEN later
can give penicillin
m...
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? - CORRECT ANSWER-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? - CORRECT ANSWER-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? - CORRECT ANSWER-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? - CORRECT ANSWER-patent
ductus arteriosus
,recurrent lymph node infxns w/ staph a in a kid. what is dx and
mechanism? - CORRECT ANSWER-chronic granulomatous dz
--> impaired phagocytic oxidative metabolism
pt hyperkalemic bc missed 2 dialysis appointments. EKG w/
peaked t waves. next step? - CORRECT ANSWER-IV calcium
gluconate --> THEN can give insulin but this works within
minutes
hyaline casts vs WBC casts? - CORRECT ANSWER--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? -
CORRECT ANSWER-pulmonary contusion
asymptomatic 57 yo M smoker, bruit in RUQ, no masses, BUN
23, Cr 1.4. what is cause of bruit? - CORRECT ANSWER-
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? - CORRECT ANSWER-
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? - CORRECT ANSWER-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? - CORRECT ANSWER-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? - CORRECT ANSWER-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? - CORRECT ANSWER-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 - CORRECT
ANSWER-negotiate a contract regarding med compliance
5 mo old w/ persistent wheezing since birth, well-nourished,
wheezing w/ extension of neck. what is cause? - CORRECT
ANSWER-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? - CORRECT ANSWER-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? - CORRECT ANSWER-ATN
--> from chronic NSAIDs
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