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NBME 13 CK2 EXAM WITH CORRECT ANSWERS 100 % VERIFIED!!
Patients with ADHD are at risk of - ANSWER Substance disorders and antisocial personality (amboss)
Winter's formula for metabolic acidosis - ANSWER PCO2 = (1.5 x HCO3) + 8 +/- 2
Used to determine if respiratory compensation is present.
Prophylactic dose for bacterial endocarditis in patients going through a high-risk procedure: - ANSWER Amoxicillin, single does of 2g 30 min prior to the procedure
Brain death can be diagnosed by - ANSWER 1. Neurologic examination (absent cranial reflexes and lack of response to painful stimuli)
- Apnea test (absent respiratory drive)
A patient comes with urinary incontinence. Urinalysis shows 50-100/hpf. What's the best next step in management? - ANSWER Cystoscopy; bladder malignancy presents with painless hematuria and urge incontinence.
Patients with cephalohematoma secondary to vacuum-assisted devices or metal forceps should be monitored for: - ANSWER Development of jaundice; serum bilirubin concentration and monitoring are advised.
The test used to confirm appropriate dosing of levothyroxine after surgical excision of pituitary tumor: - ANSWER Serum-free thyroxine (FT4) concentration
Treatment of choice for alcohol use disorder: - ANSWER Naltrexone, acamprosate, disulfiram, and gabapentin.
- Avoid naltrexone in patients taking opioids (eg, hydrocodone + acetaminophen)
A patient with SOB with exertion, crackles, and fingers clubbing. PFTs show a normal FEV1:FVC ratio and decreased DLCO. What is the diagnosis? - ANSWER Interstitial lung disease
- Other PFTs affected: low TLC, FVC, and VC.
A patient with Crohn's disease treated with sulfasalazine and prednisone present with neutropenia, thrombocytopenia, and fever. What is likely the cause? - ANSWER Adverse effect of sulfasalazine
Medications that reduce mortality in heart failure are: - ANSWER B-adrenergic antagonists (eg, metoprolol), RAAS inhibitors (eg, ACEi, ARBs), and aldosterone inhibitors (eg, spironolactone)
When indicated, what class of medication is preferable in every patient with heart failure with reduced EF? - ANSWER ACEi (eg, enalapril, ramipril)
- ARBs (eg, losartan) to those that can't tolerate ACEi
- B-blockers are added once patients are stable and compensated.
T/F: Are calcium channel blockers used in heart failure? - ANSWER False; these have negative ionotropic effects and could exacerbate symptoms.
A pregnant patient with decreased AFP has an increased risk for - ANSWER having a child with Down syndrome
- Neural tube defects, gastroschisis, and omphalocele are associated with an increased AFP
The presence of acetylcholinesterase in amniotic fluid aids to the diagnosis of - ANSWER Neural tube defect
amoxicillin. No signs of infection or fracture, what's the diagnosis? - ANSWER Transient synovitis
Treatment for hidradenitis suppurativa: - ANSWER 1. Lifestyle modification: smoking cessation, weight loss, reduce the friction.
- Mild disease: topical clindamycin or oral doxycycline.
- Mod-severe: TNFa inhibitors (eg, adalimumab)
What are good tools to improve and standardize the performance of a medical practice?
- ANSWER Plan-do-study-act (PDSA) cycle, is a process in which providers plan an intervention, execute the intervention, study it using quality measures, and identify the successes and areas of improvement for the next cycle.
- Performed just by representatives
A patient with pneumonia symptoms and images show bilateral interstitial infiltrates, what's likely the diagnosis? - ANSWER Mycoplasma pneumoniae
A healthy child presents with constipation, what's most likely the diagnosis? - ANSWER Functional constipation
- If no red flag signs (eg, failure to thrive, intermittent diarrhea) then this is most likely the diagnosis in healthy kids.
- Tx. Osmotic or Polyethylene glycol-based laxatives.
A 72-yo patient with hypertension and a history of atherosclerosis (eg, carotid endarterectomy) is treated with ACEi (eg, lisinopril) to control BP. Two weeks later creatinine 3.6 BUN 46. What's the cause of the kidney injury? - ANSWER Bilateral renal artery stenosis, secondary to atherosclerosis. Unilateral stenosis is not affected by the use of ACEi, but in bilateral decrease in BP leads to AKI.
- Tx. Angioplasty or stenting
A 1-day-old newborn has difficulty feeding. He feeds slowly and doesn't have a vigorous
suck or loud cry. His mother's grip strength is 4/5 and has difficulty releasing her grip. What's the diagnosis? - ANSWER Myotonic dystrophy
-The key finding is dysfunctional muscle relaxation.
A patient with facial reddening and flushing. History and examination are normal. Labs: Hb 18, HCT 56%, WBC 12k and PLT 550k. What's likely the diagnosis? - ANSWER Polycythemia vera, which presents a marked increase in erythrocyte mass and HCT causes hyperviscosity syndrome.
Definitive treatment of Hereditary Spherocytosis: - ANSWER Splenectomy
- Cholecystectomy can also be indicated, but it is not the definitive treatment.
A 3yo patient presents with mutism after a visit with her father. The parents are divorced. Mother comes to the clinic. What's the best next step? - ANSWER Interview the father for screening of traumatic events.
- If sexual abuse is suspected, notify child protective service
- Tx. Psych support and for PTSD antidepressants.
Treatment for pityriasis rosea: - ANSWER 1. Observe, resolve in 6-8 weeks
- Topical emollients (mild) or steroids (severe) for pruritus
- Acyclovir or macrolide if severe.
An 82-year-old presents with a lack of bowel movements for 2 weeks and loss of appetite for 3 days. Examination shows a cauliflower-like lesion between the vagina and rectum. What's likely the diagnosis? - ANSWER Vulvar carcinoma (squamous cell carcinoma)
A patient presents a BP of 160/100 in the right arm and 105/65 in the left arm. Heavy smoking history. No other symptoms. What's the diagnosis? - ANSWER Subclavian steal syndrome due to atherosclerosis
abdominal distention, tenderness to palpation, and decreased bowel sounds. X-rays show a dilated colon and gas in the bowel wall. What's the next best step? - ANSWER Exploratory laparotomy and partial/total colectomy due to the severity of the presentation.
What deficiency causes dermatitis, alopecia, and taste disturbances? - ANSWER Zinc
Deficiencies associated with gastric bypass: - ANSWER B1 (thiamine), B12 (Cobalamin), A, iron and zinc.
When do you start vaccination in infants? - ANSWER Recommended annually above the age of 6 months.
Imaging studies for osteosarcoma: - ANSWER X-rays (initial evaluation) followed by MRI (delineation of the lesion)
T/F: Is loperamide associated with C. difficile - ANSWER True; slows colonic motility and clearance, hence prolonging the exposure to C difficile toxin
management of frostbite - ANSWER - Rapid rewarming of affected areas is best done in a whirlpool bath containing a mild antiseptic at 40°C-41°C
- Reduce ambulation if lower limbs are involved.
- Pain control during rewarming.
- Extent of injury may take hours to days to assess.
Treatment for conversion disorder: - ANSWER Education about the diagnosis, physical therapy, and CBT.
- Most symptoms resolve in a few weeks.
Initial diagnostic management for urinary incontinence - ANSWER - Focused history and physical examination.
- Initial tests: urinalysis and post-void residual volume (PVR)
- If renal pathology is suspected, perform a renal US, creatinine, and BUN.
Prophylactic treatment for migraine. - ANSWER First-line: Anticonvulsants (eg, topiramate, Divalproex) and β-blockers (eg, propranolol)
Second-line: TCAs (ie, amitriptyline) and Ca2+ channel blockers
Image of cherry angiomas - ANSWER Tx. is not indicated.
Diagnosis of chronic bacterial prostatitis: - ANSWER Urine recollection before and after prostatic massage for culture and microscopy.
- Increased 10x bacterial concentration is considered diagnostic.
First line treatment for cardiogenic shock - ANSWER Dobutamine and dopamine
A patient presents with nausea and vomiting for the past 36 hours. Temp 38, jaundice, and tenderness in the right upper quadrant. Labs: WBC 5.8k, Bilirubin total 11, direct 2.2, AST 1095, ALT 1300. What's the diagnosis? - ANSWER Viral hepatitis
- In this question, the key lies in the DDx, the others don't elevate hepatic enzymes much or at all.
A patient with left renal agenesia and right hydronephrosis. Creatinine 1.3, abdomen soft and non-distended. Best step to prevent progression? - ANSWER Insert a right percutaneous nephrostomy tube (proximal obstruction)
- Urinary catheter (distal obstruction) if the patient presents signs (eg, suprapubic mass palpated, overflow incontinence)
Cutoff time for when PCI is preferred - ANSWER Within 120 minutes of the first medical contact
(90 minutes optimal door-to-balloon time)
Eisenmenger syndrome - ANSWER Reversal of L-R shunt to an R-L shunt, with cyanosis and finger clubbing.
A 47yo patient comes with a 6-month history of back pain. Worst when she sits for long periods or rises from sitting-to-standing position. No trauma, leg pain, or prior treatment. Pain to palpation at the level of L4-5. Rest is normal. What's likely the diagnosis? - ANSWER Degenerative disc disease (most common cause of chronic back pain).
- Dx. x-ray series of lumbar spine
- Tx. NSAIDs, cold/warm compresses, weight loss, activity modificatio,n and PT.
Membranous nephropathy treatment - ANSWER 1. exclude/treat underlying causes
- RAAS inhibitors (ei, ACEi, or ARBs) - renal protection.
- Prednisone PLUS another immunosuppressant (eg, cyclophosphamide, mycophenolate)
Valvulopathy associated with rheumatic fever: - ANSWER Mitral insufficiency in the acute phase and stenosis later in life.
Lung mass associated with hypercalcemia: - ANSWER Squamous cell carcinoma
intussusception CT scan - ANSWER
Metabolic disturbance in laxative overuse: - ANSWER Hypokalemia, metabolic alkalosis
A patient with a UTI is treated with piperacillin-tazobactam and gentamicin. What's an important step in the management of this patient evolution to avoid acute renal failure? - ANSWER Measure plasma gentamicin (aminoglycosides are nephrotoxic).
Screening for diabetes - ANSWER Hb A1C in all ≥35 years, or <35 years who are
overweight or obese.
What's the most common carpal bone fracture? - ANSWER Scaphoid fracture
- falling onto an outstretched hand
Common complications of scaphoid fracture: - ANSWER Nonunion or necrosis due to distal blood supply.
Diagnosis of obstructive sleep apnea - ANSWER polysomnography
Treatment for epithelioid sarcoma - ANSWER Amputation due to aggressive nature.
Which is the preferred imaging modality for heart failure? - ANSWER Transthoracic echocardiogram
A patient comes with edema on the lips after a Thanksgiving meal. Medical history of hypertension treated with lisinopril. Physical examination shows edema of the lips and no associated skin lesions. In addition to antihistamines, what's the best next step? - ANSWER Dx. hereditary angioedema (absence of urticaria differentiates from anaphylaxis)
- Discontinuation of lisinopril best next step to preventbradykininn increase.
Frontotemporal Dementia treatment: - ANSWER Atypical antipsychotics (eg, risperidone) to manage irritability and agitation.
- If depressed: SSRIs (eg, citalopram)
A patient with diabetes presents with weakness in the left extensor hallucis longus, tibialis anterior, and peroneus brevis. What's likely the diagnosis? - ANSWER Peroneal mononeuropathy
- The peroneal nerve is responsible for ankle dorsiflexion and eversion; resultings in foot drop.
Chronic: 1. allopurinol, 2. probenecid, 3. pegloticase (recombinant uricase)
- Administer anti-inflammatory before to avoid acute flare.
A patient with bone pain, kidney dysfunction, monoclonal gammopathy, and lytic bone lesion. What's the diagnosis? - ANSWER Multiple myeloma
- Cause nephrotic syndrome due to amyloidosis
A patient comes with loss of right eye vision, headaches, fatigue, and proximal extremity weakness. Erythrocyte sedimentation is 85 (NL: 0-15 (M)/20 (F)). What's the treatment? - ANSWER Prednisone therapy for temporal arteritis.
Treatment of peripheral artery disease - ANSWER 1. Aggressive risk factor modifications (smoking cessation, control of DM, HTN, HLD)
- Beta-blockers, ACE-I, statins, progressive exercise, and supervised exercise programs reduce symptoms of claudication
- Anti-platelet therapy with ASA and/or clopidogrel used routinely unless contraindicated.
