NBME Answer Keys

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Step 2 CK NBME 1

Block 1 1. C (none of other options provides evidence of peritonitis) 2. B 3. B 4. B (increase in reticulocyte count, with African American patient using TMP-SMX >> probably hemolytic anemia secondary to G6PD deficiency) 5. C (Dementia, decreased gag reflex, increase risk of aspiration pneumonia) 6. F 7. D 8. C (epidural + increased postvoid residual urine >> overflow incontinence) 9. I (Pseudodementia secondary to Major Depression. Hints: trouble sleeping, decreased appetite, psychomotor retardation, a flat affect, past history of treatment response.) 10. H 11. C (hint: relief of wheezing with neck extension >> vascular ring) 12. A (Nursemaid's elbow, subluxation of radial head) 13. G (probably secondary to Arnold Chiari malformation) 14. C (always do US to confirm gestational age when there is abnormal MSAFP level) 15. F 16. C (low protein diet >> low BUN) 17. B (CT is investigation of choice for Diverticulitis) 18. F (DiGeorge syndrome) 19. E 20. D (Eaton Lambert syndrome) 21. B 22. D (suspect sexual abuse) 23. B 24. E 25. D 26. D 27. No picture with offline NBME. Other keys say A. 28. A (Aortic regurgitation, Marfan syndrome) 29. B 30. B 31. E (Coarctation of Aorta) 32. C (Gallstone ileus, hints: the pattern of air in X ray) 33. C (Epidural also causes Bradycardia. Patient is Tachycardic, so A option is out.) 34. A 35. B 36. D (a hematoma [E] would have resolved by now. Tumors are often noticed after injury.) 37. E (buzz-word: macro-orchidism) 38. B 39. E* 40. D 41. C 42. A (Eczema herpeticum: numerous umbilicated vescicles superimposed on healing atopic dermatitis)43. C 44. C (patient has resistent depression and a very high risk of another suicide attempt >> contraindication for transplant) 45. A 46. D Block 2

1. D (decreased reflex and decreased vibration sense are part of normal aging.) 2. D (diabetic ketoacidosis) 3. A 4. D (Erythema nodosum, extraintestinal manifestation of IBD)5. D 6. E 7. F 8. E 9. G 10. C (Osteoblastic lesions >> prostate mets) 11. E (Patient-controlled analgesia is the treatment of choice for moderate to severe postop pain)

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NBME Answer Keys

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12. D 13. B (wikipedia: "GGT is elevated by large quantities of alcohol ingestion. Isolated elevation or disproportionate elevation compared to other liver enzymes (such as ALP or ALT) may indicate alcohol abuse or alcoholic liver disease.") 14. E (thoughts of suicide and infanticide >> indications for hospitalization) 15. C (COPD and Peripheral arterial disease >> contraindications for BetaBlockers) 16. D (typical description of murmur) 17. G 18. A (Echo to diagnose cardiac tamponade. There is some controversy whether the term Paracentesis can be used synonymously with Pericardiocentesis. If it can be, then E might be the answer given the hemodynamic instability.) 19. H 20. N 21. B 22. B (MMSE score less than 24 indicates dementia) 23. E 24. E 25. E (Both Influenza and DT are indicated in this person. however, as they do not mention the time of the year [influenza given only at the start of flu season] so DT looks more likely answer) 26. C ((thrombocytopenia >> thrombocytopenia) 27. D (hint: anaphylactic reaction to blood transfusion) 28. E 29. A 30. A 31. A 32. D (Mycoplasma pneumonia) 33. B 34. F (hints: calcifications anterior to the vertebral bodies+ BP 105/65 mm Hg) 35. E 36. E 37. D 38. D 39. No picture with offline NBME 40. E (only option that is employed for acne) 41. D (pap-smear is only done up till age 65, mammography up till 70) 42. D 43. B (hint: multiple tender spots over the neck, shoulders, and lumbar spine)44. B (ACEI show mortality benefit, ARBs do not) 45. B 46. B (ECG changes with hyperkalemia >> immediate IV calcium gluconate)

Block 3 1. F (Addison's disease) 2. C (dilated cardiomyopathy secondary to viral myocarditis) 3. B (persistent vomiting: low Cl, high HCO3) 4. B (mastoiditis) 5. E 6. C 7. A (simple uncomplicated lumber disk herniaton) 8. C 9. A 10. E (Imaging studies are not sensitive for the diagnosis of endometriosis) 11. C 12. C 13. A (+ive Progestin challenge test >> anovulation) 14. E 15. D 16. A (septic emboli from infectious endocarditis) 17. B 18. G 19. C (IV drug abuse >> HIV) 20. D 21. C (Its PE so heparin. In fat embolism there is petechial rash in the axilla and neck ans also bilateral patchy infiltrates on CXR.) 22. A 23. A 24. C 25. C (depressive patient >> rule out suicidal ideation) 26. C (scurvy) 27. A

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NBME Answer Keys

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28. E 29. A 30. B (intussusception) 31. B 32. B (Pica >> Fe deficiency anemia) 33. E (Lithium >> thyroid dysfunction) 34. B (milk is low in Fe) 35. A 36. D (Type II diabetes may have increased levels of insulin due to insulin resistance) 37. A (Heparin induced thrombocytopenia) 38. B (TMP-SMX) 39. A (All other are contraindicated in pregnancy) 40. A (there is no reason to examine the patient or do any tests) 41. D (temporal arteritis) 42. C ( LDL is calculated indirectly using the formula C = H+ L + kT where H is HDL cholesterol, L is LDL cholesterol, C is total cholesterol, T are triglycerides, and k is 0.20 if the quantities are measured in mg/dl and 0.45 if in mmol/l. Because LDL is normal, correct answer is to repeat about five years.) 43. E 44. D (inconsistent condom use >> screen for STDs) 45. B 46. G

Block 4 1. H (Chronic hyponatremia >> fluid restriction) 2. E (Thymoma associated with Myasthenia gravis) 3. D (Immunosuppression with typical X ray pattern) 4. D 5. D 6. G (optic neuritis) 7. F (carpal tunnel syndrome) 8. P 9. B (Pompe's disease >> floppy infant appearance, feeding difficulties, macroglossia, hepatomegaly, and heart failure from a progressively hypertrophic cardiomyopathy) 10. A (Pheochromocytoma) 11. H 12. A (estrogen can increase sex hormone binding protein, cause testosterone unavailable, cause decreased libido) 13. I (Vitamin K deficiency) 14. B 15. B (if the patient was middle aged, it could be Berger's, option D) 16. D 17. C 18. E (too late for any prophylaxis now) 19. C (adrenoleukodystrophy) 20. B (hint: lung mets) 21. A 22. C (hyaline casts can be seen in setting of dehydration) 23. E 24. D (Crohn's disease) 25. A 26. E 27. B (negative strep test in children needs to be confirmed by Throat culture because Strep A is common and carries dangerous sequlae and needs to be excluded) 28. B 29. E 30. A 31. D 32. D (analgesic nephropathy) 33. B 34. D 35. A (yogurt and cottage cheese are low in lactose. Probably a case of irritable bowel syndrome) 36. G 37. F 38. E 39. E 40. B

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NBME Answer Keys

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41. B 42. C (HIV seems more likely compared to other options) 43. B 44. E 45. F 46. C (Haloperidol decanoate for non compliant patients in depot form. Fluphenazine can also be given as a depot form but as fluphenazine decanoate but not fluphenazine hydrochloride.)

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5/4/2013