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NBME 9 REVIEW EXAM WITH CORRECT ANSWERS 100 % VERIFIED!!
Who should receive PCV13 vaccine? - ANSWER Patients with HIV, lymphoma, leukemia,multiple myeloma, functional or anatomic asplenia, ESRD, cochlear implants, CSF leaks, hx solid organ transplant, immunodeficiencies Post-transplant lymphoproliferative disorder - ANSWER EBV (monoclonal Blymphocytes)
Type of cells increased in multiple myeloma - ANSWER B cells (monoclonal spike) --multiple myeloma is a disorder of plasma cell proliferation; plasma cells are terminally differentiated B cells, thus it is considered a B-lymphocyte malignancy Alk phos levels in hemolysis - ANSWER Normal (alk phos is elevated in the case of biliaryobstruction -- hemolysis occurs before this point)
Medication options for acute depression in a patient with bipolar - ANSWER Lithium,lamotrigine, quetiapine, lurasidone
How to diagnose botulism - ANSWER Repetitive nerve stimulation studies(electromyography) --> improves with repeated stimulation
Prevention of stroke in a patient with a fib - ANSWER Warfarin (anticoagulation) Vestibular neuronitis - ANSWER Inflammation of vestibular portion of cranial nerve VIII -commonly after viral infection
Acute vertigo, nausea, vomiting, nystagmus (horizontal or rotary), gait instability --episodic!
Basilar migraine - ANSWER Begins with brainstem aura symptoms - vertigo,incoordination, tinnitus, hearing loss, diplopia, dysarthria
Symptoms last only a few minutes to an hour and are followed by headache (occipital) Treatment of diaper candidiasis - ANSWER Topical nystatin JIA - female child with oligoarthritis and positive ANA titers; what should you evaluation- ANSWER Slit-lamp evaluation (uveitis is common and often asymptomatic until it has led to complications) Treatment SVT - ANSWER 1 - adenosine, vagal maneuvers 2- beta blocker or calcium channel blockers if refractory *if hemodynamically unstable, immediate electrical cardioversion Next step in a patient who does not respond to PPI - ANSWER 24 hour esophageal pHmonitoring
When is hemodialysis indicated in AKI? - ANSWER Severe acidemia, electrolytedisturbances (hyperkalemia), volume overload or uremia (N/V, AMS)
Factor VIII deficiency, lab studies - ANSWER Prolonged PTT; normal everything else Pap with atypical glandular cells, next step - ANSWER Colposcopy with endocervicalcurettage (need to sample both cervix and endometrium)
Management of secondary hypertension in hyperaldosteronism - ANSWERSpironolactone! (aldosterone receptor antagonist - diminished effects of aldosterone on renal collecting tubule, results in decreased sodium reabsorption and potassiumsecretion)
Treatment of meniere disease - ANSWER lifestyle modification - avoidance of salt,nicotine, alcohol and stress
meclizine or promethazine for episodic vertigo Most common cause of tinea capitis - ANSWER Trichophyton tonsurans Xray shows evidence of bone destruction with irregular ragged, radiolucent defects andnew bone formation in 15 year old boy - ANSWER Most likely osteosarcoma (very aggressive and metastasizes often) - need to biopsy the bone and treat withchemotherapy and surgical resection
JVD that increases with inspiration - ANSWER Kussmaul sign (constrictive pericarditis) Kussmaul sign - ANSWER JVD increases with inspiration - sign of impaired rightventricular filling
Causes include constrictive pericarditis, restrictive cardiomyopathy, pericardialeffusion, large PE, tricuspid stenosis, severe R heart failure
Patient with alcohol use disorder presents with 3 day history of fever and coughproductive of blood-tinged, green sputum. CXR shows infiltrate in middle of right lung with dense area of consolidation. Vitals: temp 102F, BP 110/65. What is best next step? -ANSWER Antibiotics + blood cultures (suspect aspiration pneumonia - this patient also presents with sepsis) Umbilical hernia in child should spontaneously resolve by what age - ANSWER 3 If umbilical hernia in a child does not spontaneously resolve, what is most likelyoutcome? - ANSWER Progressive enlargement of umbilical ring
Imaging for nephrolithiasis - ANSWER CT scan without contrast Can a patient with migraine with aura use vaginal ring for contraception? - ANSWER No -ANY type of estrogen-containing contraception is contraindicated in these patients (increased stroke risk) Post thyroidectomy - signs of low calcium - ANSWER Hypoparathyroidism (low calcium,high phosphate)
Type of rash in meningococcemia - ANSWER Petechial Ring enhancing lesion in cerebral hemisphere, crosses corpus callosum to other side ofbrain - ANSWER Glioblastoma
How does glioblastoma commonly present - ANSWER Headaches, seizures, focal neurodeficits (visual symptoms, motor weakness, cognitive impairment)
Most significant risk factor for alzhemiers - ANSWER advanced age Initial treatment of nonketotic hyperosmolar state - ANSWER IV fluid resuscitation (0.9%saline)
Adverse effects of MDMA (ecstasy) - ANSWER Autonomic instability (hypertension,tachycardia, hyperthermia), cardio toxicity, severe hyponatremia
Also can see agitation, teeth grinding, diaphoresis, blurry vision Treatment of sickle cell pain crisis - ANSWER Pain management, hydration, maintainingoxygenation (low O2 sat may be a sign of acute chest - treat aggressively)!
IV hydration, 100% supplemental oxygen, emergency hyperbaric therapy Screening in Marfans - ANSWER echo, ophthalmic eval Most common ocular findings in Marfans - ANSWER Lens subluxation, myopia Attributable risk - ANSWER Incidence of disease in those with exposure - incidence ofdisease in those without exposure
18 year old with 3 cm supraclavicular lymph node that is firm and rubbery. Spleen ispalpated 3 cm below left costal margin. Most likely diagnosis? - ANSWER Hodgkin lymphoma Hodgkin lymphoma lab findings - ANSWER Elevated ESR, LDH Hodgkin lymphoma lymph node biopsy shows - ANSWER Reed Sternberg cells Diagnosis of renal artery stenosis - ANSWER Either renal artery Doppler U/S or MRangiography
ACE inhibitors in renal artery stenosis? - ANSWER Only if unilateral! (if bilateral stenosisexists, can lead to acute kidney failure)
Respiratory distress after meconium aspiration - ANSWER Pulmonary hypertension Cause of confusion in hyperosmolar hyperglycemic state - ANSWER Hyperosmolality Reason for hyponatremia in hyperosmolar hyperglycemic state - ANSWER
Pseduohyponatremia (as a result of profound hyperglycemia) Is there ketoacidosis in HHS? - ANSWER No! (limited basal insulin secretion is typicallysufficient to avoid profound ketogenesis)
Cardiotoxicity of doxorubicin - ANSWER Dilated cardiomyopathy --> congestive heartfailure
Common mineral deficiency in alcohol use disorder - ANSWER Magnesium, iron, zinc Common vitamin deficiencies in alcohol use disorder - ANSWER Thiamine, folate, B12,vitamin A, vitamin B
Progressive, painless loss of peripheral vision - ANSWER Glaucoma - check withtonometry
Increased optic cupping - ANSWER Glaucoma What to avoid in SJS/TEN - ANSWER Steroids and debridement Best management of SJS/TEN - ANSWER Intensive support and wound management in aburn unit
Risk of long term NSAID use - ANSWER Impaired renal function Next step if patient presents to ED with unstable angina - ANSWER Admit forobservation - serial EKGs, troponins, cardiology consult, stress test or cath
4/6 systolic murmur best heart at left sternal border, increases with Valsalva - ANSWERHOCM
Berylliosis risk factor - ANSWER Aerospace and nuclear engineering background Mass at angle of mandible, next step? - ANSWER FNA biopsy Congenital reduction of glucuronyltransferase - ANSWER Gilberts disease(unconjugated hyperbilirubinemia)
Risk factor for placenta accreta - ANSWER Prior C section and the presence of placentaprevia
*ie. if you have a placenta previa and you had previous C- sections, your risk forplacenta accreta goes up
Recommendation for patient with MS to reduce symptoms - ANSWER Avoid heat(transient symptom exacerbation in high environmental temperatures)
Features of soft tissue mass that are concerning for malignancy - ANSWER Tumorincreasing in size, lack of pain, firmness
Treatment of chlamydia in pregnancy - ANSWER Azithromycin PTHrP associated with what lung cancer - ANSWER Squamous cell carcinoma of thelung
What paraneoplastic syndromes are associated with small cell lung cancer? - ANSWERCushing syndrome, SIADH, Lambert-Eaton
pH decrease expected in chronic respiratory failure - ANSWER pH falls by 0.03 mm Hgfor every increase in PCO2 by 10 mm Hg (this is due to kidney compensation for chronic CO2 retention)
