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NBME 11 WITH COMPLETE SOLUTIONS 100 % VERIFIED!!
Heat exhaustionexercise intolerance, increased core body temperatures, and the absence of neurologic disturbances Heat strokeis characterized by hyperthermia, AMS or neurologic deficits, and variable physical signs and symptoms depending on severity Stimulus induced or spontaneous myoclonus is specific for?Creutzfeldt-Jakob disease
What is the first line treatment for narrow complex SVT?AV nodal blockage with adenosine
Bradford Hill Criteria for Causalitytemporal relationship, strength of association, dose-response relationship, Consistency, biological plossibility, Consideration of alternate explanations, experiment,Specificity, coherence
BCG and PPD testBCG effects wanes 5 years after vaccination
Diagnosis of empyemaThoracentesis: frank pus or cloudy fluid in pleural space. Pleural fluid: leukocytosis, pH <7.20, glucose <60 mg/dL, high LDH, elevated protein, maybe infectious organisms. Recommendation of treatment is with chest tube placement What is the initial management of mild carpal tunnel syndrome?ergonomic changes to relieve the pressure ( Ex. Wrist pad for keyboard) or splinting
What are the risk factors for in-hospital mortality in a patient with a PE?Advanced age and obstructive shock
Pediatric Hypertensionmeasurement of serum renin and aldosterone, serum and urine metanephrinphrines, and renal US with doppler to assess the patency of the renal arteries What is a distinguishing feature of opioid intoxication?Miosis
CLABSIcentral line associated blood stream infection workup includes drawing blood from the CVC and another place while starting IV antibiotics
Daily antibiotic prophylatic to help prevent infections and complications Serum sicknesssystemic injury initiated by antigen-antibody complexes that circulate in the blood CM: Fever, Rash, arthralgias and arthritis Following non-human medications like Inflixamab or equine botulism toxin antibody Inhalant abuse1. glue, tuolene, nitrous oxide
- signs of acute intoxication - transient, brief euphoria + loss of consciousness3. immediate effects lasting 15-45 minutes
- CNS depressants - may cause death5. dermatitis around mouth or nostrils is apparent
- liver function tests - may be elevated with repeated use7. Able to cause nystagmus, AMS, Headache Suspect in young children and adolescents Malariafever, fatigue, chills and anemia in a patient with recent endenmic exposure
Adenomyosisbenign invasive growth of the endometrium that may cause heavy, painful menstrual bleeding. Presents with an enlarged boggy uterus on exam. Treatment is hysterectomy. Primary hyperadolsteroismPresents with hypertension, Metabolic alklaosis, hypokalemia, Increased aldosterone levels and decreased renin levels
Why does primary aldosterosim present with hypokalemia?Aldosterone functions at the DCT to reabsorb NA and thus water in exchange for K and H. Vaccinarelated virus used in smallpox vaccine
Small pox presentationFebrile prodromal phase followed by a vesciular rash The rash is typically limited to the face and upper chest and is notably with vesicles inthe same stage of development. Lesions tend to scab over in 2 weeks. Treatment issupportive.
What is a common cause of hypocalcemia in a patient with Celiac disease?Osteomalacia due to decreased Vitamin D absorption from the inflammed proximal small bowel; also present with secondary hyperparathyroidism with low phosphorous as well. osteodystrophyPresent with pseudohypoparathyroidism which results in hypocalcemia. CM: Short stature, developmental delay and round facies Acute exacerbations seen in a person with bronchiestasis require what for managment?Antibioitcs; typically IV
REM sleep behavior disordera neurological disorder in which the person does not become paralyzed during REM sleep and thus acts out dreams. It can be idiopathic or associated with alpha synucleindeposition such as that seen in Parkinson disease
Cardiac contusiona bruise to the heart wall caused by severe blunt trauma to the chest where the heart is violently compressed between the sternum and the spinal column Management of cardiac contusion with an abnormal ECG finding on initial exam?Admission for continuous ECG monitoring
Atrial fibrillation management with a normal rateNo management is necessary
aseptic meningitisfever, headache, stiff neck. CSF would show normal glucose, with elevated protein, and lymphocytosis. Enteroviruses (coxsackie, echo, and polioviruses) are responsibelefor >90% of cases.
Hemodynamic profile of acute decompensated heart failureDecreased SV, Decreased CI, Increased CVP, Increased PCWP and Increased SVR
What needs to be performed in a patient with RA before general anesthetic?Lateral XR of the cervical spine on flexion and extension
VHL syndromehemangioblastomas, clear cell renal carcinoma, pheochromocytoma AD What vaccines should asplenic patients receive?HIb, Meninogoccal, and pneumococcal
Familial Short Stature14 y/o boy, always been below 5% in height. Father is 5'2" and mom is 4'10" Bone age = Real age. Patients with new onset dyspnea or symptoms of angina should be evaluated by?Stress test
In a patient with abdominal blunt trauma...if the patient is hemodynamically unstable with tachycardia and hypotension the patient should undergo an emergent laparomoty osteochondromaa benign bony projection covered with cartilage. Common in adolescents. XR with a peduncluated or sessile tumor. Often be palpated at joints in the knees and ankles ofpatients
Chondroblastomabenign bone tumor, <20; epiphyseal/metaphyseal. Present with bone pain and low grade fevers. Aortic valve insuffiency murmurPresents as a diastolic decrescendo murmur that can lead to signs of heart failure
Recall bias. These problems arise in retrospective studies.When people with the disease are more able to recall exposure to certain things, because they may find that the exposure caused their disease or was associated A infant who has a history of constipation since 1 week of age despite severalsupportive factors and whom presents with an enlarged bowel should be considered tohave? Hirssprung disease and be elevatued with either barium enema, rectal manometryand/or a rectal suction biopsy
treatment of preterm labormagnesium sulfate for neuroprotection less than 32 corticosteroids for fetal lung maturation less than 34Antibiotics for GBS tocolytics to reduce contractions ( nifedipine) Alcohol use can cause EDPatients should be counseled to abstain from alcohol and see if that helps
Febrile transfusion reactionrecipient anti-HLA antibodies react against donor leukocytes First step is to stop the transfusion and collect labs such as a CBC, haptoglobin, LDH to
False negativeAssessment error in which no pathology is noted (that is, test results are negative) when one is actually present. type 2 error In a patient with volume overload and new onset HFrEF the first step in management is?Treatment of the overload with furosemide and ACEI before reassessing he need for a beta blocker An underdeveloped or small uterusTurner syndrome, 45 XO
Conversion disorderPresents with neurologic manifestations that are not explained by the presence of lab testing. Management is with pyschotherapy and discussion fo the disease with thepatient and family
Tubular polyp presence requires CRC screening every5-10 years
Pneumococcal polysaccaride vaccine 23
Starts to be administered at the age of 65Those with cardiac, liver, diabetes, pulmonary or alcohol may receive the vaccine earlier than age 65 In a homeless patient with a spontaneous abortion what is the next best step inmanagement? Suction curettage Dubin johnson syndromePresents with elevated conjugated hyperbilirubin due to a defective conjugate bilirubin transportation. What diet has been shown to reduce morbidity and mortality in patients with a previousMI? Mediterrerean diet; which is high in grains, fruits and vegetables Stress fracture treatmentcast immobilization
Tinea capitisscaly patches with alopecia and associated LAD. Hair can be broken down to the base. Can be prevented by sharing hats, combs and other things that are used by a personinfected.
In patient in whom an obvious arterial injury is apparent what is the next step inmanagement? Operative wound exploration A patient with signs of proximal muscle weakness with muscle tenderness on exam whostarted on a statin 6 months prior should have what test performed? CK levels monitor to check for a myopathy that can be induced by statin usage What is the diagnostic study of choice for a suspected urethra injury?Retrograde uterography Straddle- anteriorPelvic- posterior injury
Treatment of chronic renal failureMinimize fluid, limit potassium intake, limit phosphorous
Hashimotos thyroditischarcterized by the presence of antithyroid peroxidase antibodies and antithyroglobin antibodies. Chronic disease presents with signs and symptoms of hypothyroidism. Graves disease
Hyperthryoidism with the presence of thyroid stimulating antibodies What are some severe adverse effects of Valproic acid?Thrombocytopenia and hepatoxicity
Achlasia Ciguatera posioningfound in eel and large reef fish. CM include reversal of hot and cold temperatures, paresthesias and GI upset ARDScharacterized by acute onset of bilateral, noncardiogenic infiltrates and respiratory failure. ARDS results from cytokine mediated injury to the pulmonary paraenchyma Treatment for ankle sprianRest, ice, elevation, brace and physical therapy
Breast cancer screeningEvery 1-2 years starting at age 40 to 74. At 75, can occur if life expectancy is greater than 10 years
Present as a hyperkeratoic, crusted papule, papules or plaques that may be crusted.Solid organ transplant recepients on chronic immunosuppresants are at increased risk
microcytic anemia in pregnancyIDA
normocytic anemia in pregnancyphysiologic anemia of pregnancy. Normal expansion of red blood cell volume
Ovarian cancer treatmentSurgery and Chemotherapy
Smoking and Age greater 35Contraindication to OCP use
Overflow incontience treatmentMuscarinc- bethanecol
Overactive bladder treatmentOxybuynin
what therapy can be given to patients who are allergic to bees?Venom immunotherapy to decrease their sensitivity to bees in the future
Impetigo treatmenttopical mupricon
