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NBME 10 EXAM QUESTIONS AND CORRECT ANSWERS
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11-year-old girl presents With tanner stage one of the pubic hair, she has a flat left breast and the right breast is tender and a small mass
What is the best next step? - ANSWER Reassurance
This is normal thelarche and can be asymmetric
Order of maturation in female - ANSWER Thelarche, pubarcge, growth spurt, menarche
27-year-old man presents with thrombocytopenia, eczema and recurrent infections - ANSWER Wiskott-Aldrich, WAS gene,
Patient comes in with ulcerative colitis Treated with prednisone mesalamine and much more and the doctor decides to add a regimen, due to the addition of the regimen what should be tested next - ANSWER Tuberculosis screening, due to initiation of TNF alpha inhibitor
Patient with sickle cell disease comes in with vaso-occlusive crisis it is given pain control what else should be given with the pain control? - ANSWER Intravenous fluids
Patient with a MI 10 years ago Comes to the hospital due to vomiting. The patient ends up getting a transfusion and 30 minutes later starts developing shortness of breath, what is the most likely cause? - ANSWER Transfusion associated circulatory overload
Remember: patience with ABO incompatibility present with flank pain and hypotension
Treatment of transfusion associate circulatory overload - ANSWER Oxygen and positive pressure ventilation And possible directions
Can lead to psychosis, bizarre behavior, agitation, aggression, nystagmus and ataxia
treatment - ANSWER PCP intoxication
Treatment: IM lorazepam or Midazolam
38-year-old woman comes in due to seizures, MRI demonstrates unilateral or bilateral temporal lobe abnormalities, what is the next best step? - ANSWER Lumbar puncture: HSV encephalitis
If a patient has stroke like symptoms occurring less than 4 1/2 half hours Without signs of hemorrhage what is administered? - ANSWER Alteplase
If the patient comes in with a stroke in the amount of time is unknown, with no evidence of hemorrhage what is administered? - ANSWER Aspirin instead of alteplase
Bell's palsy Presents with facial nerve palsy causing facial paralysis that doesn't spread the forehead, what is the next best step?
Treatment: - ANSWER It's diagnose clinically, no further testing indicated
Treatment: glucocorticoids and occasionally antiviral therapy
Patient after gastric bypass presents with ataxia, altered mental status and opthalmoplegia including nystagmus, most likely cause? - ANSWER Vit B1 def
Immunocompetent child with cervical lymphadenitis presents with a purpleish hue, And presence of multiple granulomas on excisional biopsy - ANSWER Purpleish hue: mycobacterium infection
Patient presents with a 2 cm ulcer on the foot and new mid back pain, what is the most likely cause and what is the next best step to confirm the diagnosis? - ANSWER Vertebral osteomyelitis, MRI of the lumbar spine.
Can occur through hematogenous spread
artery hypertension
Lead to local inflammatory response and classically presents with fever in lower left quadrant abdominal pain and bloody diarrhea is less frequent - ANSWER Diverticulitis
Acute abdominal pain in the setting of a recent MI that shows the fuse tenderness most prominent in the left lower quadrant - ANSWER Ischemic colitis
Beta three agonist used to treat overactive bladder - ANSWER Mirabegron
Female with a recent fetal demise With a new pregnancy should undergo - ANSWER Non-stress testing in the third trimester for the next pregnancy
What most likely determines a patient's risk for diabetic nephropathy - ANSWER Measurement of urine microalbumin concentration
Men 1 tumors - ANSWER Pituitary, parathyroid, pancreatic
MEN 2A tumors - ANSWER Medullary carcinoma of the thyroid, pheochromocytoma, parathyroid
Men 2B tumors - ANSWER Medullary carcinoma of the thyroid, pheochromocytoma, neuroma's
Commonly causes diseases in immunocompromise patients in the setting of severe ulcerative colitis, solid organ or allergenic bone marrow transplant Tatian or HIV/aids. Intracellular inclusion bodies are classically observed
Treatment - ANSWER CMV colitis treat with ganciclovir or valganciclovir
Attributable risk - ANSWER AR = [a/a + b] − [c/c + d]
Patient comes in with a severe head injury after a motorcycle collision presents with fixed and dilated pupils unresponsive to all physical and verbal stimuli, no cranial reflexes EEG with no electrical activity. Asks what is the most accurate regarding continuation of mechanical ventilation? - ANSWER Mechanical ventilation can be withdrawn without patient's families permission due to patient being brain dead
Any patient with new onset of A.fib should undergo - ANSWER TSH measurement
Crohn's disease can lead to small bowel obstruction due to - ANSWER Forming small bowel structures
Patient presents with abdominal aneurysm measuring 7 cm and pancreatic Adenocarcinoma, what do you do? Do you fix the aneurysm - ANSWER No because of the patients poor prognosis
Patient with bacteremia and disseminated intravascular coagulation With hypotension, has an increase in creatinine from 1.5 to 3 - ANSWER ATN
Mainly caused by medication's Such as antibiotics, NSIADs, PPIs, infections or autoimmune disorders - ANSWER AIN
After dilation and curettage the beta hCG should drop if it drops and goes back up into the thousands what is your diagnosis? - ANSWER Gestational trophoblastic neoplasia
Pregnant females with SLE or Sjogren are increased risk for what Kind of cardiac issue in the infant - ANSWER AV block
Patient with anaphylactic shock is treated with epinephrine and - ANSWER Normal saline
Pentad of patients with TTP pay close attention, what is treatment? - ANSWER Fever
syndrome - ANSWER Cholesterol emboli
So first line treatment for mild hyponatremia in a patient who is having diarrhea who is also able to take in proper fluids and has normal appetite - ANSWER Oral rehydration
What is contraindicated when delivering an infant with a mother who is HIV positive - ANSWER Placement of fetal scalp electrodes
Protective factors for ovarian cancer - ANSWER OCPs for over five years, lactation, multiple pregnancies, bilateral salpingo-oophorectomy
Patient with Klinefelter's can present with short stature 5 foot five being 17 years old low BMI, minimal facial hair, mild bilateral gynecomastia, testes Tanner one - ANSWER
Number one step in treating a patient with DKA - ANSWER Saline infusion followed by insulin then electrolyte
He sure with the long history of consuming prednisone and has low blood pressure think of and treat with - ANSWER Adrenal crisis treat with corticosteroid therapy
Next best step for patient swallowing Drano - ANSWER Esophagoscopy
Formula for relative risk - ANSWER [a/(a+b)]/[c/(c+d)]
Number needed to Treat - ANSWER 1/ARR
ARR= control - treatment
The safety, toxicity and pharmacologic properties of a drug or determined in which phase clinical trial - ANSWER Phase 1
A clinical trial that compares the efficacy of the new intervention to the current standard of care or placebo in a large number of patients which phase - ANSWER Phase 3
What improves validity of clinical trials - ANSWER Randomization, controlled, double blind
Patience with multiple myeloma are prone to what type of infections - ANSWER Infections with encapsulated organisms
SHiN EColi Klebsiella Salmonella Group B
When a fertilized egg implants into the endometrial lining but an embryo fails to develop, often due to severe fetal chromosomal abnormalities - ANSWER Blighted ovum
Patient presents with infective endocarditis what is the next best step - ANSWER Blood cultures before giving antibiotics makes perfect sense
Call me immunoglobulin that is found within the mucosal membrane's - ANSWER IGA
Causes erythematous call Ms. slightly edematous papule at the sight of the sand fly bite may increase in size an old street or become wart like. Hyperkeratotic eschar may form
Treatment of Pseudo gout - ANSWER Oral NSAIDs
Typically presents with pain and weakness in the direction of shoulder motion and a positive drop arm test - ANSWER Rotator cuff tear
Most common form of superventricular tachycardia - ANSWER Atrial ventricular nodal reentrant tachycardia
SVTs can be provoked by alcohol, caffeine call Mike surgeon, stress or
For a patient with papillary or follicular thyroid cancer what is helpful in monitoring if there's secondary recurrence of cancer - ANSWER Thyroglobulin
First-line therapy in patients with cardiogenic shock - ANSWER Dobutamine, dopamine, norepinephrine
The difference in risk mortality between two groups can be expressed by - ANSWER Hazards ratio
Positive predictive value varies directly with - ANSWER Prevalence
Negative predictive value varies inversely with - ANSWER Prevalence
A technique in which statistical analysis are conducted after the data has been collected and seen by investigators - ANSWER Post hoc analysis
Treatment of oral candidiasis - ANSWER Fluconazole
Treatment for MS, acute flares - ANSWER Corticosteroids
Treatment for MS, long-term - ANSWER Interferon beta therapy or monoclonal antibodies
Strongest modifiable risk factor for stroke - ANSWER Hypertension
Strongest non-modifiable risk factor for stroke - ANSWER Age
Mucocutaneous bleeding or bruising with thrombocytopenia without any other abnormalities - ANSWER Immune thrombocytopenic purpura
Treatment of ITP in adults - ANSWER prednisone (IVIG if refractory) if refractory and not respondent to any of these therapies -> splenectomy
Medication that causes agranulocytosis leading to pharyngitis and neutropenia - ANSWER Trimethoprim sulfamethoxazole
Patients with headaches can induce their symptoms by over using medication for headaches - ANSWER Discontinue
Most common important risk factor for anencephaly as well as caudal neural tube defects - ANSWER Folate deficiency
Accumulation of blood within the anterior chamber of the eye - ANSWER Hyphema
Describe Felty syndrome - ANSWER rheumatoid arthritis (joint arthralgias)
Neutropenia
Splenomegaly
Impairment of ankle dorsiflexion (foot drop), great toe extension and foot diversion along with sensory loss of dorsum of the foot - ANSWER Common peroneal neuropathy
Weakness of hip flexion, knee extension, diminished patellar reflex and impaired sensation of the anterior thigh - ANSWER Femoral neuropathy
Impairment in hip adduction and sensation of the medial proximal thigh - ANSWER Obturator neuropathy
Weakness of ankle plantar flexion along with pain and sensory loss of skin overlying the buttock thigh and posterior leg - ANSWER S1 radiculopathy
Presents with fever, myalgias, headache, tachycardia and hypotension. Seen after giving penicillin for treatment of syphilis - ANSWER Jarisch Herxheimer
Complication of umbilical artery catheterization - ANSWER Renal artery thrombosis leading to hypertension
Elevation of renin and aldosterone
Management of foreign body aspiration - ANSWER Bronchoscopy can be therapeutic and diagnostic
Treatment of IBS - ANSWER Loperamide
