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NBME CBSE Form 4 2023 Exams NBME CBSE Form 4 (2 Versions) 2023/2024
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NBME CBSE Form 4 Latest Version/ NBME CBSE Form 4 Actual Exams and Study Guides/ NBME CBSE Form 4 (2 Versions)
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NBME CBSE Form 4 Latest Version/ NBME CBSE Form 4 Actual Exams and Study Guides/ NBME CBSE Form 4 (2 Versions) ( Questions and Answers)/ NBME CBSE EXAM 55 yo - admitted to hospital in coma following sudden collapse PMHx: recent CABG for CAD ECG: wide QRS complexes (160 ms) w/ vent rate of 170/min and atrial rate of 110/min most app initial step in mgnt? ----------- Correct Answer -------- direct current countershock aka DC cardioversion > synchronized shock - use for anything besides VFib or pulseless VTach OME: tachy, wide QRS - most likely VTach > since pt is unstable - SHOCK > if stable - amiodarone 37 yo - f/u exam PMHx: RF 2/2 PKD - hemodialysis 3 yrs ago: Td toxoid, 23 -valent pneumo vaccine 12 months ago: influenza virus vaccin e PE: gucci hep panel: HBsAb pos most app vaccine to administer? ----------- Correct Answer -------- influenza virus should be given annually pneumo vaccinations: > PCV13 for all adults > 65 yo - followed by PPSV23 6 -12 months later ~ do this for adults < 65 yo w/ very high -risk underlying conditions (CSF leak, sickle cell dz, cochlear implants, congenital/acquired asplenia, immunocompromised status, CRF) > *PPSV23 alone for pts < 65 yo who are current smokers or have certain chronic med conditions (heart/lung dz, DM, chronic liver dz)* Td booster q10 yrs 32 yo - admitted 8 hrs after onset of n/v and epigastric abd pain radiating to her back > 2 similar episodes during past 2 months no PMHx SHx: doesn't drink alcohol PE: mod epigastric tenderness labs: WNL Hgb, Hct, plt; inc WBC, amylase (1450) US GB: gucci CT abd: mass in pancreas next step in dx? ----------- Correct Answer -------- endoscopic retrograde cholangiopancreatography drain symptomatic panc pseudocysts w / ERCP or you. need ERCP to dx what is causing her acute pancreatitis (since both alcohol and gallstones have been eliminated) 37 yo - 1 yr of progressive SOB > now SOB after walking 200 ft > unable to keep up w/ soccer players (coach) > occasional whee zing and nonproductive cough SHx: no cigs/alcohol; wife resumed smoking 18 months ago after quitting for 3 yrs; 3 healthy kids FHx: dad - died of alcoholic cirrhosis at 55 yo RR: 20/min POx (room air): 90% PE: end -exp wheezes and occasional rhonchi BL CXR: inc lucency and bullous changes BL bases most likely cause of pt's condition? ----------- Correct Answer -------- alpha1 -antitrypsin deficiency young pt presenting w/ COPD symptoms def inc by second -hand tobacco smoke dad died from cirrhosis - liver also affected by this enzyme def > up in the air if cirrhosis was strictly from alcohol or if there's a genetic component here bullous emphysema - seen in COPD > bulla = permanent, air -filled space w/in the lung parenchyma that is at least 1 cm in size and has a thin or poorly defined wall ~ bordered only by remnants of alveolar septae and/or pleura CXR: inc lucency at lung bases = panlobular emphysema > destruction involves prox/distal acini > predilection for lung bases 72 yo - burning, aching pain in distal ext for 3 wks > pain exacerbated by lowering ext; relieved by elevation PE: tenderness/swelling of fingers and wrist/knee/ankle/toe joints; overlying skin warm/erythematous; clubbing of fingers/toes most likely to be abn ormal? ----------- Correct Answer -------- X-ray of the chest clubbing of fingers and toes = hypertrophic osteoarthropathy HOA - syndrome of clubbing of the digits, periostitis of the long (tubular) bones, and arthritis Emma Holiday - this suggests under lying lung malignancy 56 yo - 1 day of epigastric pain/vomiting PE: scleral icterus; tender epigastrium labs: inc WBC (inc neutrophils); inc BR 4.4 (direct 3.3); inc triG (210); inc amylase (1350); ink alk phos (320) US: dilation of intrahepatic ducts most likely cause of condition? ----------- Correct Answer -------- choledocholithiasis aka gallstones in CBD symptoms when present: +Murphy's sign; +inf (inc WBC, fever); RUQ/epigastric pain; jaundice dx: > RUQ US: initial study; dilated ducts > ERCP/M RCP: gold standard tx: > NPO, IVF, IV AB > ERCP > lap cholecystectomy in severe cases > f/u: ball -valve effect - stone going back/forth high amylase = blockage at panc duct inc direct BR = blockage of CBD inc alk phos = cholestatic pattern of dz (and eliminates all liver options) 32 yo - progressive sensory loss for 1 wk > initially: feet felt numb > slowly ascended symmetrically to umbilicus > urinary urgency/freq; nocturia > tight band -like sensation around midabd region PE: slowing of L.e ye ADduction during saccadic movement of eyes to the right; diffuse hyperreflexia; sens to pinprick dec to level of umbilicus most likely explanation for slowing of L.eye ADduction is a lesion where? ----------- Correct Answer -------- left medial longitu dinal fasciculus homegirl has internuclear ophthalmoplegia - MS lesion in MLF results in ipsi medial rectus palsy on attempted lat gaze (ADduction defect) and horizontal nystagmus of ABducting eye (CL to side of lesion) > lac rectus > CNVI nuclei > CL MLF > med rectus diplopia can occur MS features involve different areas of the CNS - inability to attribute them all to one localizing lesion other features: transient sens deficits (MC initial presentation); fatigue; motor symptoms (weakness/spasti city); cerebellar/cerebral involvement; loss of bladder control; ANS involvement (impotence/constipation); neuropathic pain mgnt: acute flares - high-dose IV corticosteroids; chronic - IFN (glatiramer, tingolimod); symptomatic (baclofen, gabapentin, betha nechol/amitriptyline) 58 yo - extreme fatigue and malaise for 3 wks > 5 wks ago: toothache - root canal procedure PMHx: cardiac murmur (noted at 19 yo) 100F P: 110/min PE: lungs clear; 2/6 sys murmur - 2nd R.ICS, S4, ejection click labs: dec Hgb; WNL W BC (inc segs, bands); inc ESR 90 UA: blood pos blood cxs obtained most likely underlying cardiac abnormality? ----------- Correct Answer -------- calcification of a bicuspid aortic valve pay attention to how they describe the murmur - systolic, at 2nd R.ICS murmur at young age of 19 yo - congenital cause AS > inc LV pressure > hypertrophy and stiffening of LV > S4 bad toothache is prob hinting to endocarditis > bacteria (prob S.viridans ) traveled from teeth and caused vegetations on calcified/already diseased AV dx: Duke criteria > major: sustained bacteremia; endocardial involvement or new valvular regurg > minor: predisposing condition (abnormal valve); fever; vascular phenomena; im mune phenomena (glomerulonephritis, Osler nodes, Roth spots, RF); + blood cx or + echo not meeting major criteria > require 2 major, 1 major + 3 minor, or 5 minor 30 yo - recurrent aching R.shoulder pain by reaching overhead > occurs at night in bed > most prominent in area of deltoid PE: elicited by ABduction of shoulder against resistance most likely site of underlying condition? ----------- Correct Answer -------- supraspinatous tendon homeboy prob tore his rotation cuff when you add resistance to ABduction - differentiate bet deltoid and supraspinatus pain on overhead ABduction due to impingement of supraspinatus tendon bet acromion and humerus pts may localize the pain to the lat deltoid and often describe pain at night esp when lying on the aff ected shoulder life table shown - compares natural dx hx of groups A and B which group at which time has poorest 1 yr survival rate? ----------- Correct Answer -------- group B at year 3 -4 sorry you need the actual picture for this (% survival on y -axis and yrs on x -axis) basically look at the slopes (rates) of each lines and see who has the biggest drop 24 yo - f/u exam 2 months ago: red, scaly rash over groin > 6 wks of topical clotrimazole ~ recurred 2 days ago SHx: sex active w/ 1 partner - condoms PE: erythematous, excoriated rash over groin; similar to instep of L.foot KOH prep: hyphae most likely cause of pt's recurrent infection? ----------- Correct Answer -------- autoinfection tinea cruris (jock's itch) a nd tinea pedis (athlete's foot) the question is (annoyingly) asking for why two diff areas are affected > reinfected self from scratching foot and touching groin area > typically spread from the feet to the groin through putting on clothes resistance is unlikely since rash went away w/ 1st round of tx 42 yo - gradual onset of greasy, diffuse scaling of scalp w/ variable itching over past yr
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