NBME 7 Answers Kathy

NBME 7 block 1 answeres 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) 22) 23) 24) 25) 26) 27) 28) 29) 30) 31) 32) 33) 34) 35) 36) 37) 38) 39)

A angina = exercise stress test B fat emboli syndrome A repeat BP in 4 weeks A diabetes insipidus B central vein occlusion G small bowel obstruction D bilateral varicocele >> high temperature >> impaired spermatogenesis B decreased calcium caused by low Mg due to malnutrition E pilosebaceous follicles , acne D normal heart sound, upper respiratory tract infection C haloperidol for acute delirium E meningitis with focal neurological sign, CT scan first if focal signs present, then LP C child abuse , retinal Haemarrhage E Myaesthenia gravis >> thymoma A honey crusted > impetigo> topical mupirocin E pregnancy causes urinary stasis F nystagmus >> PCP B zenker diverticulum >> barium swallow A myasethenia gravis >> autoantibodies against postsynaptic ACH receptors D Gullain Barre syndrome >> axonal demyelination E surgical exploration L widened mediastinum + C5 fracture >> thoracic aorta A reassurance C family therapy , D sarcoidosis >> increased calcium E randomized controlled trial is the only interventional study listed, the rest are observational studies D pancytopenia + lymadenopathy + hepatomegaly >> suspect ALL >> BM aspiration G strangulated inguinal hernia >> need urgent surgery A renal stone colic >> increased fluid intake E alternating QRS + cardiomegaly >> cardiac temponade E gout acute attack>> indomethacin D no active lesions now >> can deliver vaginally B statin induced myopathy >> painful>> muscle lysis due to blockage of Coenzyme Q synthesis E terminal CA patient >> give adequate analgesic that is needed C mania episode >> bipolar C premature menopause >> low estrogen >> osteoporosis E hereditary spherocytosis E contrast induced nephropathy >> give IV fluid to prevent C hyperglycemia >> polyuria >> low intravascular volume >> orthostatic hypotension

40) D salad >> myonoise >> staph aureus poisioning due to preformed toxin >>due to inadequate refrigeration 41) A bamboo spine >> ankylosing spondyloytis 42) B compression fracture due to prednisolone use of asthama 43) E acute pancreatitis can b caused by hypertriglyceridemia 44) G T lymphocyte dysfunction >> fungal and mycobacteria infection 45) D positive PPD + negative CXR and sputum >> start latent TB treatment now If negative PPD >> then repeat PPD again 46) No question

BLOCK 2 NBME 7 answers 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15) 16) 17) 18) 19) 20) 21) 22) 23) 24) 25) 26) 27)

B flat affect >> major depression E dental work >> strept viridans A lyme >> amoxil B nursemaid elbow >> treatment is gentle supination and flexion B determine if patient wants to discuss with anyone else H wound dehiscene (serosangunioius discharge + wound tenderness + distension) C heat stroke > body temperature 106 D fever plus neurologiv plus schistocytes D OCPills decrease risk of ovarian cancer and endometrial cancer C osteoarthirits >> 20 degree flexion hip contracture C post cholecystectomy >> common bile duct stricture>> need ERCP B organophosphate poisoining >> antidote atropine B tacile hallucinations with cocaine and amphetamines C 27 weeks gestation >> need IM betamethasone for surfantant maturation D uterine atony cos of big baby. (9Lb) A B12 deficiency >> atrophic gastritis due to lack of intrinsic factor, schilling test proves it A pneumococcal, H influenza, meningococcal >> all capsulated organisms >> due to impaired B lymphocyte thus low Ig thus impaired opsonizatoin F repeated staph aureus (catalase positive organism >> chronic granulomatous disease due to NADPH oxidase deficiency in neutrophils) D high calcium, low phosphate >> hyperparathyroid >> increased urinary calcim excretion B H influenza >> COPD + lobar pneumonia + gram neg bacilli B multiple painful sores >> genital herpes E cricothyroidectom >> facial fracture + unstable cervical spine C HOCM murmur gets louder on standing B amyotrophic lateral sclerosis > fibrillation potentials in multiple muscles of extremities A education about puberty to parents and child B low PO2, high PCO2 >> alveolar hypoventilation C young patient, no warning signs >> trial of PPI first

28) 29) 30) 31) 32) 33) 34) 35) 36) 37) 38) 39) 40) 41) 42) 43) 44) 45) 46)

E Rh incompatibility C acute urticaira + angioedema D pneumococcal C 6 hours is just about the time GA effect wears off>> child starts to feel pain F vagovagal syncope >> HR during syncope is 45/min. if hypoglycemia, should b tachycardia D NO cleaving of C terminal peptides on angiotensin 1, (mechanism of action of ACE) C renal ultrasound, could b obstructive uropathy due to tumor >> will show hydronephrosis D antidote for heroin >> Naloxone A botulism >> pupil dilation (MS GBS doesn’t affect pupils) E urethral diverticulum >> midline mass in vaginal wall B low cardiac index >> cardiogenic shock >> high PCWP >> acute pulmonary edema>> give diuretics A ETEC A PCOS >> give clomiphene E if HBS antibodies are already present >> no treatment or vaccine or Ig is necessary C diuretics causes low K >> digoxin toxicity >> premature ventricular beats E metastasis to bone >> hyper Ca >> confusion E stenosis above 70% >> carotid enarterectomy A wide based gait >> cerebellar degeneration due to alcohol >> abstinence from alcohol D congestive cardiac failure ( perihilar haziness with upper lobe veins dilation)

BLOCK 3 answers 1) 2) 3) 4) 5) 6) 7) 8) 9) 10) 11) 12) 13) 14) 15)

D digestive enzyme deficiency >> lactose intolerance C epidural haematoma compressing the spinal cord A brisk rotatory nystagmus needs futhur evaluation B hypothyroid C thiamine deficiency B C1 esterase inhibitor deficiency >> hereditary angioedema D measurement of serum amylase activity, acute pancreatitis C pre eclampsia >> check platelet count to rule out HELLP syndrome B atherosclerosis of femoropopliteal arteries D achalasia >> decreased peristalsis, increase LES tone F lorazepam therapy >> MRI claustrophobia) A CXR >> due to decreased breath sound at left lung base, high WBC count, low grade fever D psychogenic polydipsia >> low serum Na, low urine osmolarity B central umblication >> molluscum contigiosum > check HIV F tenderness at tibial tubercle >> Osgood schlatter>> repeated microfracture at tendon insertion

16) 17) 18) 19) 20) 21) 22) 23) 24) 25) 26) 27) 28) 29) 30) 31) 32) 33) 34) 35) 36) 37) 38) 39) 40) 41) 42) 43) 44) 45) 46)

A DVT >> duplex scan A subconjuctiva hamarrhage >> reassurance A bartholin duct cyst A tenderness on palpation >> costchondritis A low cardiac index , high PCWP >> cardiogenic shock A lead poisoning > calcium disodium edetate No question No question B cor pulomale due to right heart failure due to pulmonary embolism E SLE H paget’s disease of breast B ductal ectasia B mixed metabolic acidosis and respiratory alkalosis >> use winter’s formula E CS section, station too high for forceps and giving oxytocin will futher deteriorate fetal late deceleration A allergic bronchopulmonary aspergillosis B brief psychotic disorder >> auditory hallucination of brother’s voice D GBS prophylaxis >> IV pen G A pituitary microadenoma >> prolactinoma >> medical therapy C fever + pharyngitis + splenomegaly >> EBV A acute stress disorder F multiple myeloma > abnormal IG > abnormal opsonization > increased risk for capsulated organism infection > strept pneumonia C piles >> need to exclude Ca colon compressing the venous drainage> colonoscopy E aortic dissection D acute tubular necrosis D increase sensitivity, decrease specificity B high eosinophils > parasite > cutaneous larva migrans A acute cholecystitis A need to look for synchromnous or metachronous tumor>> colonoscopy B xray of left hip A aspiration >> pneumonia No question

BLOCK 4 1. E TPN + Hais loss >> zinc deficiency 2. C destruction and dilation of distal airways >> emphysema 3. C colposcopy

4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 34. 35. 36. 37. 38. 39. 40. 41. 42. 43. 44. 45.

Statsis dermatitis with ulcer, ( no question) G schizophrenia C hypovolemia due to severe nausea and vomiting of acute pancreatitis D acute lymphcytic leukemia >> increased LDH No question. Answer B B dopamine No question answer oral PTU ( graves) E fluid rescuitiation failure >> give blood transfusion F amurosis fugax + stroke > internal carotid artery A abruption placenta E spondylolisthesis E spinal dysraphism >> club foot and loss of motar sensory F wiskoff Aldrich syndrome C IV 0.9% Normal saline A acute myocardial infarct >> ST elevation in V2 V3 V4 I ventricular tachycardia >> wide QRS complex E staphyloccous aureus >> vancomycin C magnesium sulfate >> tocolysis E organophosphate poisioning H pulmonary embolism >> pulmonary infarct > pleuritic chest pain A observation B torticollis >> fibrosis of sternomastoid muscle A bronchogenic carcinoma I schizophrenia >> olanzapine therapy E PID C cryoglobulinemia > treat the cause > hep C > treatment is IL alpha D give all recommended immunizations for age E no intervention is necessary No question C diabetic nephropathy >> add Lisinopril F pill induced oesophagitis D SIADH low serum Na, high urine osmolarity A mitral valve incompetence, rheumatic fever F surreptitious administration of thyroxine G viral infection D pleural metastases E radiation therapy. vertebral metastasis compressing spinal cord B optic neuritis E no therapy indicated at this time B appendicitis C finasteride, ( patient has orthostatic hypotension so doxazosin cant b used) A coercion of a vulnerable population

46. A observation