©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
IM NBME Form 2 Exam Practice Questions and Answers
62 yo - L.hemiparesis resolves completely in 2 hrs
BP: 140/90 mmHg
PE: R.carotid bruit
ECG, CBC, head CT - gucci
next step in dx? - Ans:✔✔-duplex ultrasonography of the carotid arteries
probably had TIA
> lasts bet few minutes - 24 hrs
> symptoms transient bc repercussion occurs - either from collateral circulation or breaking up of an
embolus
> usually embolic
> although transient HoTN in presence of severe carotid stenosis (>75%) can lead to TIA
screen all pts w/ carotid duplex US who have carotid bruit, PVD, and/or CAD
62 yo - 3 months of mildly inc SOB
Page 1/52
, ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
PMHx: 3 yrs of COPD
SHx: smokes 1 pack qd for 40 yrs - quit 3 yrs ago when dx
RR: 16/min
BP: 138/76 mmHg
pulm exam: mildly dec air movement; occasional wheeze
ABG: pH, pCO2 - WNL; dec PO2 (74)
next step in mgnt? - Ans:✔✔-ipratropium therapy
tx COPD w/ bronchodilators
> since albuterol isn't an option > choose another bronchodilator (antichol drug)
give steroids and ABs for acute exacerbations
67 yo - 3 days of fever, cough productive of dark sputum, pleuritic chest pain, SOB
> prior to these symptoms: runny nose, nasal congestion, mild sore throat
101.2 F
P: 92/min
Page 2/52
, ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
RR: 18/min
BP: 146/86 mmHg
PE: bronchial breath sounds in LLL, dullness to percussion
CXR: LLL infiltrate; pleural effusion
thoracentesis: yellow fluid
labs:
> serum: glucose (105), protein (7.2), LDH (55)
> pleural fluid: 1025 RBC, 3500 WBC (90% segs), glucose (80), protein (6.5), triG (30), amylase (30), LDH
(95), pH 6.9
gram stain: seg neutrophils and gram pos diplococci
cx of fluid: pending
most likely dx? - Ans:✔✔-empyema
pus + gram stain w/ bacteria
use Light's criteria to confirm exudate:
> Pprotein:Sprotein > 0.5
Page 3/52
, ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
> PLDH: SLDH > 0.6
> pleural fluid LDH > 2/3x upper limit of normal for serum
42 yo - 1 month of prog SOB
> no fever, cough productive of purulent/blood-tinged sputum
> receiving chronic O2 for tx of dyspnea
SHx: no smoking
FHx: younger bro - single lung transplant for COPD (1 yr ago)
BMI: 20
RR: 24/min
PE: breath sounds dec; BL basilar crackles
CXR: hyperlucent lung fields most prominent at bases; flattened diaphragms
most likely explanation for findings? - Ans:✔✔-abnormality of antiprotease resulting in destruction of
alveolar supporting structures
alpha1 antitrypsin def
CXR: flattened diaphragms = COPD
Page 4/52
FIRST PUBLISH OCTOBER 2024
IM NBME Form 2 Exam Practice Questions and Answers
62 yo - L.hemiparesis resolves completely in 2 hrs
BP: 140/90 mmHg
PE: R.carotid bruit
ECG, CBC, head CT - gucci
next step in dx? - Ans:✔✔-duplex ultrasonography of the carotid arteries
probably had TIA
> lasts bet few minutes - 24 hrs
> symptoms transient bc repercussion occurs - either from collateral circulation or breaking up of an
embolus
> usually embolic
> although transient HoTN in presence of severe carotid stenosis (>75%) can lead to TIA
screen all pts w/ carotid duplex US who have carotid bruit, PVD, and/or CAD
62 yo - 3 months of mildly inc SOB
Page 1/52
, ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
PMHx: 3 yrs of COPD
SHx: smokes 1 pack qd for 40 yrs - quit 3 yrs ago when dx
RR: 16/min
BP: 138/76 mmHg
pulm exam: mildly dec air movement; occasional wheeze
ABG: pH, pCO2 - WNL; dec PO2 (74)
next step in mgnt? - Ans:✔✔-ipratropium therapy
tx COPD w/ bronchodilators
> since albuterol isn't an option > choose another bronchodilator (antichol drug)
give steroids and ABs for acute exacerbations
67 yo - 3 days of fever, cough productive of dark sputum, pleuritic chest pain, SOB
> prior to these symptoms: runny nose, nasal congestion, mild sore throat
101.2 F
P: 92/min
Page 2/52
, ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
RR: 18/min
BP: 146/86 mmHg
PE: bronchial breath sounds in LLL, dullness to percussion
CXR: LLL infiltrate; pleural effusion
thoracentesis: yellow fluid
labs:
> serum: glucose (105), protein (7.2), LDH (55)
> pleural fluid: 1025 RBC, 3500 WBC (90% segs), glucose (80), protein (6.5), triG (30), amylase (30), LDH
(95), pH 6.9
gram stain: seg neutrophils and gram pos diplococci
cx of fluid: pending
most likely dx? - Ans:✔✔-empyema
pus + gram stain w/ bacteria
use Light's criteria to confirm exudate:
> Pprotein:Sprotein > 0.5
Page 3/52
, ©GRACEAMELIA 2024/2025 ACADEMIC YEAR. ALL RIGHTS RESERVED
FIRST PUBLISH OCTOBER 2024
> PLDH: SLDH > 0.6
> pleural fluid LDH > 2/3x upper limit of normal for serum
42 yo - 1 month of prog SOB
> no fever, cough productive of purulent/blood-tinged sputum
> receiving chronic O2 for tx of dyspnea
SHx: no smoking
FHx: younger bro - single lung transplant for COPD (1 yr ago)
BMI: 20
RR: 24/min
PE: breath sounds dec; BL basilar crackles
CXR: hyperlucent lung fields most prominent at bases; flattened diaphragms
most likely explanation for findings? - Ans:✔✔-abnormality of antiprotease resulting in destruction of
alveolar supporting structures
alpha1 antitrypsin def
CXR: flattened diaphragms = COPD
Page 4/52
