NBME 7 - Mod

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1. When to eval for child 15-18 months 17. Torsion when to get if high clinical suspicion go right to
not walking US vs Surgery surgery (negative Prehn's, pain
remains with elevation) Need to fix
2. male infertility, ill- bilateral varicoceles
within 6hrs
defined soft masses
high in scrotum 18. acute gout attack indomethacin (high dose NSAID);
first line steroids used when NSAIDS not
3. Diabetes Inspidus Urine specific gravity <1.006;
effective
serum osm >290; Hypernatremia;
comatose after meningioma 19. Zenker vs achalasia bad breath for Zenker
surgery
20. alcoholic with 106 heat stroke
4. Why does hypoMag Mag usually inhibits Ca release temp, high CK and
cause HypoCa? from sarcoplasmic reticulum; high AST
increases intracellular Ca levels
21. anticholinergic using meds (atropine, benadryl,
which decreases PTH, decreasing
poisoning benztropine); hot, dry, blind, red, mad
Calcium
(treat with physostigmine)
5. Post-CABG: pressures tamponade - need to surgical
22. acetylcholinesterase organophosphates/insecticides:
drop, UOP decreases, explore
poisoning SLUDGE: salivation, lacrimation,
CO drops, Pulmonary
urination, defecation, GI motility,
artery diastolic pressure
emesis and miosis; (treat with
UP
atropine!)
6. upper anterior thymoma
23. urinary incontinence urethral diverticulum
mediastinal mass
with outpouching of
7. proximal muscle myositis (inflamm infiltrate with urethra into anterior
weakness myopathic changes and vaginal wall
replacement by adipose and
24. causes of watery ETEC, vibrio cholerae, Giardia, crypto,
collagen)
infectious diarrhea rota, noro
8. indications for C-section prior CS, ACTIVE herpes, cervical
25. ARDS Acute onset; Radio of PaO2/FiO2
(maternal) carcinoma, maternal trauma, HIV
<200; Diffuse infiltration bilateral with
infection
cephalization of pulmonary
9. first test for angina after stress test vasculature and perihilar fullness,
EKG Swan-Ganz wedge < 18mmHg
10. acne is from plugged pilosebaceous glands 26. ARDS treatment low tidal volume, use PEEP to recruit
alveoli
11. central retinal vein sudden, painless vision loss, assoc
occlusion with HTN, swollen disk, venous 27. Chronic gastritis in fundus due to autoantibodies to
stasis retinal hemorrhages, with B12 deficiency parietal cells, causes pernicious
cotton-wool spots, edema of anemia (assoc with other autoimmune
macula disorders) increased risk of gastric
adenocarcinoma
12. sarcoidosis SOB, painful bumps on legs
(erythema nodosum), bilateral 28. factors predisposing renal failure (decreased exretion)
hilar fullness, to toxicity of digoxin hypokalemia (dig can bind at K site on
hypercalcemia/hypercalcuria Na/K/ATPase, quinidine (decreases
dig clearance)
13. Etiology of UTI in urinary stasis from decreased
pregnancy ureteral tone with increased 29. 4 days post-op, wound dehiscence (evisceration
urinary tract volume serosanguineous would show abd contents)
fluid
14. SBO no passage of stool (flatus yes if only partial)
30. Single greatest risk Hypertension
15. nystagmus drug of PCP
factor for stroke
abuse
31. Treatment of stroke carotid endarectomy
16. Myasthenia gravis vs. MG: decreased receptors from Ab
if carotids over 70%
botulism attack; Botulism: decreased
stenosis
release
32. Cholangitis from ERCP (both diagnostic and therapeutic) 49. alcoholic with neuro deficits after thiamine (B1) ataxic
CBD injury-- test glucose infusion gait, bilateral rectus
to do palsies, horizontal
nystagmus
33. HIDA scan eval of gallbladder, used for biliary
atresia (Hepatobiliary IminoDiacetic Acid) 50. prevention of myoglobinuria renal NS IVF
failure
34. ERCP ductal problems (gallstones, strictures
[primary sclerosing cholangitis], leaks, 51. central scotoma and pupillary optic neuritis
cancer) defect
35. ERCP vs MRCP MRCP is less invasive and allows for 52. cryoglobulinemia with HepC INF-alpha
imaging around the surrounding
53. three of more consecutive PVC's, ventricular tachycardia
structures
wide QRS in regular rapid rhythm (amiodarone if stable,
36. Transhepatic visualizes anatomy of biliary tree; used cardiovert if unstable)
cholangiography AFTER ERCP has been unsuccessful;
54. rheumatic fever most common 1. mitral
mainly therapeutic as less invasive
valves 1 and 2 (stenosis/regurg) 2.
techniques for diagnosis exist (MRCP, CT,
aortic
US)
(stenosis/regurg)
37. naloxone vs naloxone: Emergency naltrexone: MARF
naltrexone withdrawal
55. tocolytics CCB (Nifedipine); B-
38. IgA Deficiency anaphylactic transfusion reaction of IgE mimetics (terbutaline,
blood antibodies against anti-IgA ritodrine);
transfusion rxn Magnesium!;
MOA
56. urine sodium over 50; urine osm SIADH
39. complement Classic pathway activated by IgG and >50; serum osm <290 with LOW
deficiency and B IgM made by B cells sodium
cell dysnfnx
57. short bowel syndrome, rash and zinc deficiency
40. TTP pentad Thrombocytopenia, Schistocytes, Fever, hair loss on TPN
Renal, Neuro
58. HSIL, next step colpscopy
41. Acute CHF LMNOP: Lasix, Morphine, Nitrates,
59. back pain that increases with spondylothesis
management Oxygen, Position UP
hyperextension
42. Rh vs ABO Rh: stillborn, severe anemia and
60. destruction and dilation of distal emphysema
Hemolytic mod/severe jaundice, strong positive
airways
Disease of Coombs, NO schistocytes (RBC's
Newborn completely phagocytosed) 61. Kid with low back pain, worse in JRA
morning/inactivity, stooped
43. cholecystitis vs. cholecystitis: pericholecystic fluid;
gait/limping?
cholangitis on cholangitis: dilated bile duct
ultrasound 62. If person with PPD greater than 16 Tx for latent Tb (INH
mm shows up, and has no other for 9 mos)
44. 3 cm nontender Bartholin duct cyst
signs, do what?
fluctant mass in
left posterior 63. Widened mediastinum after CABG, Surg exploration of
vulva decreased UOP and BP, increased mediastinum
pulm diastolic pressure, do what?
45. ATN findings renal tubular epithelial cells and
pigmented granular casts 64. Woman on oral morphine with pain Administer it q3 orally,
not controlled q4, do what? not subq
46. cor pulmonale JVD, ascites, LEE
65. Which structure is involved with the Pilosebaceous follicle
47. claudication femoropopliteal arteries
production of acne?
arteries
66. 27 year old with crohn's on ACUTE PANC!
48. hypothyroid in dementia (forgetfulness, slow gait)
azathioprine and high amylase,
elderly can
what should you think?
mimick
67. What else does azathioprine Pancreatitis, liver tox, 84. newborn in respiratory distress with Rh
do? bone marrow suppression hepatosplenomegaly high indir bili and incopatability;
petechia after term delivery and uneventful they're not
68. Bilateral nystagmus, not being PCP- may not always be
pregnancy, what is it? necessarily
aggressive, stiff and not aggressive!
stillborn!
talkative- think what?
85. Ovarian mass removed person w/renal Abdo U/S
69. High dilute urine output in DIABETES INSIPIDUS
failure, do what first?
comatose woman, after
meningioma removal, should 86. Uneventful SVD and heavy bleeding one UTERINE
make you think? hour later, what is it most likely? ATONY
70. Tx impetigo? Topical mupirocin 87. Adult with molluscum contagiosum, do what VIRAL
next? CULTURE;
71. Kid with cramping abdo pain This is strangulation, so
may have std
and r. sided scrotal pain with operation
discolored hemiscrotum with 88. Slipped CFE, first step? x-ray, not MRI
swelling and tenderness
89. 18yo with a 3cm lymph node in the neck for Increased
superiorly; do what next?
1 month and 3cm splenomegaly. what would LDH; this is
72. After ORIF and respiratory Fat embolism! you find on labs? NHL
issues, think what?
90. 27 primigravid woman with late decels who obs
73. Can it have bilateral pulmonary YES! is dilating, 7cm at hour 5, do what?
infiltrates?
91. A 19 year old African American man comes Decreased
74. Anorexic person with OSTEOPOROSIS to physician because of 9 month history of enzyme -
amenorrhea at what risk 6-12 hour episodes of intermittent watery probably
compared to people who diarrhea associated with abodominal lactose
menstruate? cramps and bloating. he occasionally has intolerant
had diarrhea after meals since the age of 12
75. Additional vac to give AIDS Pneumococcal, NOT HEP
years, but it has been worse since he
person? A! THAT'S FOR LIVER
started college 1 year ago. examination
FAILURE PEOPLE
shows no abnormalities. which of following
76. Intermittent urine loss plus Urethral diverticulum, not is the most likely cause of this pateints
cystic mass in midthird of fistula diarrhea
vagina, what is this?
92. Ascites woman with mass in the culdesac, Ovarian
77. Wehre do ACE inhibitors work in Cap receptor sites on what is it and do what? cancer; need
kidney? macula densa of the JGA ex lap to
78. Can botulism have CN effects? Yes! It inhibits ACh stage it
How does it work? release at NMJ 93. mildly itchy rash from face to extremities in This is parvo
79. 28 week pregnant woman going Betamethasone, NOT a 10 year old, do what? B 19 (THAT
into labor, do what? CERCLAGE WAS
SLAPPED
80. Fussy newborn who is sedated Give more analgesia; kid
CHEEK
and mechanically ventilated can't talk
RASH), so do
after surgery, do what?
nothing
81. Person with gerd sx and not gerd trial, if not >50, not
94. A 32 y/o women is brought to ER because of Likely
cancery, do what? >5 years, and no
a 2-day history of vomiting, diarrhea, and appendicitis
melena/anemia/wt
right-sided pelvic pain. Her LMP was 3
loss/melena/hematemesis
weeks ago.. Her vitals are T 39' C, R 20/min,
82. ALS EMG signs? fibrillation potentials in P 100/min, Bp 120/70 mm Hg, abdominal
multiple muscles of examination shows right lower quadrant
multiple extremities tenderness with rehound. bowel sounds are
83. Kid with staph aureus issuess? NEUTROPHILS; the decreased, Pelvic examination shows right
chronic granulomatous adnexal tenderness. A serum pregnancy tes
has issue with is negative. What is this?
NEUTROPHIL oxidative 95. Lesion with HSIL in 27 year old, do what? colpo
burst
96. Enlarged prostate in geezer with obstructive sx? Finasteride, not
doxasozin
97. Can ibuprofen do pill induced esophagitis? yes!
98. Pelvic fracture guy with negative fast, what does he need? PRBC; pelvic
fractures can bleed a
lot retroperitoneally
and not show up on
FAST
99. ) a previously healthy 67 year old man has had an ching burning snsation in the distal lower extremities for Bronchogenic
3 weeks, the symptoms are exacerbated by walking and relieved by elevation of the feet. The carcinoma
cetatarsalphalangeal joints and ankles are warm swolle, tender and erythematoud. There is clubbing of
the fingers and toes. which of the following is the most likely diagnosis?
100. A 4 year-old boy develops chickenpox 8 hours after visiting his newborn sister in the nursery. Six other Nothing; moms were
full-term newborns were also exposed; all of the mothers have a history of chickenpox prior to pregnancy. immune so the
Which of the following is the most appropriate recommendation to prevent chickenpox in the newborns? babies are safe for 6
mos or so.