Science Medicine Nursing
NBME step 3 pearl form 4, NBME Form 4, nbme 4 step 3
practice exam
NBME Step 3 Form 4 Practice
Exam – High-Yield Clinical
Pearls and Exam Review
(2025–2026).
polyhydramnios what is the ultrasound diagnostic If the deepest vertical pool is more than 8 cm.
Esophageal arteria
Agnathia, microstomia
di-geroge
placental insufficiency
maternal diabetes
Olanazepine
The elderly and dementia related psychosis with DO not give antipsychotics to the elderly with dementia as there is an increased
antipsychotics risk of death as shown in short term controlled trials : increased risk of death -
cardiovascular heart failure, sudden death or infections
AA with previously controlled Diabetes was started on SERUM glucose levels - No olanazpine ( as even at normal levels it causes
olanzapine prior to discharge and recently has gained 25 metabolic abnormalities)
lb what test should be tested increased risk of diabetes and hyperglycemia
always monitor blood glucose
Addison's disease Hyperpigmentation of skin and mucous membranes - 1st symptoms - most
prominent in sun exposed skin areas
Myalgias- hypokalemia
Fatigue, weigh loss, poor appetite
random symptoms - heightened sense of smell taste and hearing and salt
craving
Females have amenorrhea d/t weight loss and chronic illness
,Pt presents with dizziness while sitting and standing but ADDISONS disease
no orthostatic changes - 96/60 and only is not dizzy -exercise is a natural way to increase cortisol
while running
Sodium is 134
Potassium 3.4
Acute addison's disease prominant nausea vomting and vascular colaapse - may have an acute abdomein
with hyperpyrexia ( > 105 )
intention to treat Intention to treat (ITT) analysis means all patients who were enrolled and
randomly allocated to treatment are included in the analysis and are analysed in
the groups to which they were randomized. i.e. "once randomized, always
analyzed"
Seroma us a collection of fluid under the suture line and may occur in regions of extensive
undermining or dead space
A fib Irregularly irregular rhythm
NO P Waves
Variable ventricular rate
QRS are narrow < 120 ms unless pre-exisiting bundle branch ( if right called
ashman's phenomenon)
A flutter regular atrial activity at ~300 bpm giving a saw tooth appearance best seen in
leads 2,3, AVF
Work up for carotid artery stenosis Ultrasound is the screening test of choice
Arteriography - comes with 1-2% risk of stroke
Viral bronchitis inflammation of the trachea, bronchi, and bronchioles
Hacking cough with phlegm production and often follows an upper respiratory
infection
caused by: adenovirus, influenza, parainfluenze
Manefests as the common cold - mucoid phelgm that esolved in 7-10 days
Viral bronchiolitis Inflammation of the bronchioles that is normally caused by a viral infection -- RSV
low grade fever
apnea maybe the first symptoms in early disease
Coryza, fine rales and wheezes
who gets palivizumab infants born at less then 29 weeks should recieve palivizumab or those under 1
year with heart disease and lung disease
, Acute laryngotracheobronchitis CROUP
It is the most common etiology for hoarseness, cough, and onset of acute stridor
in febrile children.
Croup usually begins with nonspecific respiratory symptoms (ie, rhinorrhea, sore
throat, cough). Fever is generally low grade (38-39°C) but can exceed 40°C.
Within 1-2 days, the characteristic signs of hoarseness, barking cough, and
inspiratory stridor develop, often suddenly, along with a variable degree of
respiratory distress. Symptoms are perceived as worsening at night, with most ED
visits occurring between 10 pm and 4 am.
exercise programs improve the ability to do what for complete the activities of daily living
nursing home residents
What vitamin is commonly low in the elderly d/t natural Vitamine B12
gastric achlorhydria leading to macrocytosis and balence problems
Adverse effects of echinacea Abdominal pain
Allergic reactions
Altered fertility
Diarrhea
Dizziness
In evaluating hypoxia and elevated hematocrit in COPD ABG PaO2 less then 55 is related to polycythemia and if this is normal check
what should be preformed polysynography
post partum hemorrhage is defined as 500ml
MOst common cause of post partum hemorrhage Uterine atony - the failure of the urterus to contact and retract following delivery
of the baby
POsitve risk factors
-previous atony
- magnesium sulfate
- Birthweight - Larbor induction and augmentation
Neurological manefestations of rheumatoid arthritis Atlantoaxial subluxation - spastic quadriparesis is slowly progressive - Painless
senosry loss in the hands and feet
PML virus and Rheumatoid arthritis The risk of progressive multifocal leukoencephalopathy (PML), which is associated
with the polyoma JC virus, is increased in patients treated with rituximab for RA,
but the absolute risk is very small.
NBME step 3 pearl form 4, NBME Form 4, nbme 4 step 3
practice exam
NBME Step 3 Form 4 Practice
Exam – High-Yield Clinical
Pearls and Exam Review
(2025–2026).
polyhydramnios what is the ultrasound diagnostic If the deepest vertical pool is more than 8 cm.
Esophageal arteria
Agnathia, microstomia
di-geroge
placental insufficiency
maternal diabetes
Olanazepine
The elderly and dementia related psychosis with DO not give antipsychotics to the elderly with dementia as there is an increased
antipsychotics risk of death as shown in short term controlled trials : increased risk of death -
cardiovascular heart failure, sudden death or infections
AA with previously controlled Diabetes was started on SERUM glucose levels - No olanazpine ( as even at normal levels it causes
olanzapine prior to discharge and recently has gained 25 metabolic abnormalities)
lb what test should be tested increased risk of diabetes and hyperglycemia
always monitor blood glucose
Addison's disease Hyperpigmentation of skin and mucous membranes - 1st symptoms - most
prominent in sun exposed skin areas
Myalgias- hypokalemia
Fatigue, weigh loss, poor appetite
random symptoms - heightened sense of smell taste and hearing and salt
craving
Females have amenorrhea d/t weight loss and chronic illness
,Pt presents with dizziness while sitting and standing but ADDISONS disease
no orthostatic changes - 96/60 and only is not dizzy -exercise is a natural way to increase cortisol
while running
Sodium is 134
Potassium 3.4
Acute addison's disease prominant nausea vomting and vascular colaapse - may have an acute abdomein
with hyperpyrexia ( > 105 )
intention to treat Intention to treat (ITT) analysis means all patients who were enrolled and
randomly allocated to treatment are included in the analysis and are analysed in
the groups to which they were randomized. i.e. "once randomized, always
analyzed"
Seroma us a collection of fluid under the suture line and may occur in regions of extensive
undermining or dead space
A fib Irregularly irregular rhythm
NO P Waves
Variable ventricular rate
QRS are narrow < 120 ms unless pre-exisiting bundle branch ( if right called
ashman's phenomenon)
A flutter regular atrial activity at ~300 bpm giving a saw tooth appearance best seen in
leads 2,3, AVF
Work up for carotid artery stenosis Ultrasound is the screening test of choice
Arteriography - comes with 1-2% risk of stroke
Viral bronchitis inflammation of the trachea, bronchi, and bronchioles
Hacking cough with phlegm production and often follows an upper respiratory
infection
caused by: adenovirus, influenza, parainfluenze
Manefests as the common cold - mucoid phelgm that esolved in 7-10 days
Viral bronchiolitis Inflammation of the bronchioles that is normally caused by a viral infection -- RSV
low grade fever
apnea maybe the first symptoms in early disease
Coryza, fine rales and wheezes
who gets palivizumab infants born at less then 29 weeks should recieve palivizumab or those under 1
year with heart disease and lung disease
, Acute laryngotracheobronchitis CROUP
It is the most common etiology for hoarseness, cough, and onset of acute stridor
in febrile children.
Croup usually begins with nonspecific respiratory symptoms (ie, rhinorrhea, sore
throat, cough). Fever is generally low grade (38-39°C) but can exceed 40°C.
Within 1-2 days, the characteristic signs of hoarseness, barking cough, and
inspiratory stridor develop, often suddenly, along with a variable degree of
respiratory distress. Symptoms are perceived as worsening at night, with most ED
visits occurring between 10 pm and 4 am.
exercise programs improve the ability to do what for complete the activities of daily living
nursing home residents
What vitamin is commonly low in the elderly d/t natural Vitamine B12
gastric achlorhydria leading to macrocytosis and balence problems
Adverse effects of echinacea Abdominal pain
Allergic reactions
Altered fertility
Diarrhea
Dizziness
In evaluating hypoxia and elevated hematocrit in COPD ABG PaO2 less then 55 is related to polycythemia and if this is normal check
what should be preformed polysynography
post partum hemorrhage is defined as 500ml
MOst common cause of post partum hemorrhage Uterine atony - the failure of the urterus to contact and retract following delivery
of the baby
POsitve risk factors
-previous atony
- magnesium sulfate
- Birthweight - Larbor induction and augmentation
Neurological manefestations of rheumatoid arthritis Atlantoaxial subluxation - spastic quadriparesis is slowly progressive - Painless
senosry loss in the hands and feet
PML virus and Rheumatoid arthritis The risk of progressive multifocal leukoencephalopathy (PML), which is associated
with the polyoma JC virus, is increased in patients treated with rituximab for RA,
but the absolute risk is very small.
