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NBME EXAM QUESTIONS AND ANSWERS
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NBME EXAM QUESTIONS AND ANSWERS
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NBME EXAM QUESTIONS AND ANSWERS25 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
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
42 yo M progressive swelling of legs, hx of stage IIA hodgkin dz 1 yrs ago treated w/
rads, hypotension, JVD that increased w/ inspiration, heart sounds distant, ascites, what
is mechanism of pt's increased central venous pressure? - constrictive pericarditis -->
hx of radiation + Kussmaul sign
schizophrenic pt w/ delusions presents to hospital. recently hospitalized but then
stopped all meds. what is best pharmacotherapy to decrease pt's chance of
readmission? - haloperidol decanoate --> long acting injection
52 yo M smoker x20 years w/ no complaints. father died of MI at 62, in addition to
starting serum cholesterol and exercise program, what is next best step? - exercise
stress test --> to look for ischemia
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