NBME 9 STEP 2 Questions 100%
correct, expert verified answers
Patients with HIV infection and other immunocompromising conditions should receive both
pneumococcal vaccines
PCV13 first in patients with HIV followed by PPSV23 at least 8 weeks later.
Human herpesvirus 6 can cause pneumonitis, myelitis, encephalitis, and hepatitis in transplant
recipients, however, is unlikely to be the causative agent of PTLD.
JC virus progressive multifocal leukoencephalopathy
condition that can occur in patients after solid organ or bone marrow transplant as a result of
reactivation of the JC virus. Classic clinical features include altered mental status, diplopia, seizures,
ataxia, and motor deficits. Pathologic specimens show demyelination
post-transplant lymphoproliferative disorder may occur in patients after solid organ or stem cell
transplants as a result of reactivation of latent EBV infection.
Clinical symptoms depend upon the location of the subsequent B lymphocyte mass, and treatment
involves de-escalation of immunosuppression with or without rituximab and regimens for primary B
lymphocyte neoplasms.
Extravascular hemolysis labs? Patients with hemolysis present with varying degrees of anemia
and reticulocytosis in addition to increased concentration of indirect bilirubin and LOH. Direct bilirubin
and ALP, both of which are increased in instances of biliary obstruction, should be normal.
acute dystonic reaction tx? Treatment involves anticholinergic medications, such as
diphenhydramine or benztropine, which restore the dopaminergic-cholinergic balance in the basal
ganglia.
,Next step in diagnosis for botulism in infant? The diagnosis is supported by a characteristic low
amplitude response on repetitive nerve stimulation studies that improves with repeated stimulation.
Next step in diagnosis for Guillain-Barre syndrome MRI of the spine
Meniere disease condition of vestibular dysfunction and sensorineural hearing loss that results
from pressure accumulation in the endolymph of the inner ear.
Patients typically present with episodic vertigo, hearing loss, and tinnitus. This patient's course is
constant rather than episodic and does not include hearing loss.
Vestibular neuronitis inflammation of the vestibular portion of the vestibulocochlear nerve.
Vestibular neuronitis typically presents with acute vertigo, nausea, vomiting, nystagmus, and gait
instability. Hearing loss is atypical. Vertical nystagmus and other nonvestibular symptoms would indicate
a central cause of vertigo.
Candidiasis diaper rash tx? can be recognized by its red, macerated thin plaques with satellite
papules
Topical nystatin cream is the first-line therapy in treating diaper candidiasis.
first-line therapy for the treatment of mild to moderate acne vulgaris? Topical retinoids
They should be used over the entire involved area to prevent new comedone formation rather than
applied as "spot treatment" only to existing lesions.
Use of bactericidal soap is sometimes used as an adjuvant to topical retinoid therapy
, Juvenile rheumatoid arthritis most appropriate screening test? A slit-lamp examination allows for
high magnification viewing of the anterior chamber and can detect subtle signs of intraocular
inflammation
Enchondroma benign bone tumor that often occurs in the metacarpals and phalanges of the
fingers
treated with observation alone
OIiier disease & Maffucci syndrome multiple enchondromas that may present in a single
extremity
multiple enchondromas and soft tissue angiomas.
Giant cell tumor of bone nonmalignant but is aggressive and may invade local structures
often arises in the distal femur
Histologically, it contain giant cells and mononuclear stromal cells. The presence of a spiculated lung
lesion makes metastatic lung cancer a more likely diagnosis.
Osteosarcoma most common type of primary bone cancer and occurs frequently above the knee
in the distal femur or below the knee in the proximal tibia.
initial presentation often includes pain and swelling; sometimes, a fragility fracture is the declaring
presentation. It is most common in patients under 30 years of age.
Destructive bone lesions in adults are most commonly the result of metastatic disease rather
than a primary bone malignancy. Cancers that commonly metastasize to bone include lung, breast,
thyroid, kidney, and prostate cancer.
correct, expert verified answers
Patients with HIV infection and other immunocompromising conditions should receive both
pneumococcal vaccines
PCV13 first in patients with HIV followed by PPSV23 at least 8 weeks later.
Human herpesvirus 6 can cause pneumonitis, myelitis, encephalitis, and hepatitis in transplant
recipients, however, is unlikely to be the causative agent of PTLD.
JC virus progressive multifocal leukoencephalopathy
condition that can occur in patients after solid organ or bone marrow transplant as a result of
reactivation of the JC virus. Classic clinical features include altered mental status, diplopia, seizures,
ataxia, and motor deficits. Pathologic specimens show demyelination
post-transplant lymphoproliferative disorder may occur in patients after solid organ or stem cell
transplants as a result of reactivation of latent EBV infection.
Clinical symptoms depend upon the location of the subsequent B lymphocyte mass, and treatment
involves de-escalation of immunosuppression with or without rituximab and regimens for primary B
lymphocyte neoplasms.
Extravascular hemolysis labs? Patients with hemolysis present with varying degrees of anemia
and reticulocytosis in addition to increased concentration of indirect bilirubin and LOH. Direct bilirubin
and ALP, both of which are increased in instances of biliary obstruction, should be normal.
acute dystonic reaction tx? Treatment involves anticholinergic medications, such as
diphenhydramine or benztropine, which restore the dopaminergic-cholinergic balance in the basal
ganglia.
,Next step in diagnosis for botulism in infant? The diagnosis is supported by a characteristic low
amplitude response on repetitive nerve stimulation studies that improves with repeated stimulation.
Next step in diagnosis for Guillain-Barre syndrome MRI of the spine
Meniere disease condition of vestibular dysfunction and sensorineural hearing loss that results
from pressure accumulation in the endolymph of the inner ear.
Patients typically present with episodic vertigo, hearing loss, and tinnitus. This patient's course is
constant rather than episodic and does not include hearing loss.
Vestibular neuronitis inflammation of the vestibular portion of the vestibulocochlear nerve.
Vestibular neuronitis typically presents with acute vertigo, nausea, vomiting, nystagmus, and gait
instability. Hearing loss is atypical. Vertical nystagmus and other nonvestibular symptoms would indicate
a central cause of vertigo.
Candidiasis diaper rash tx? can be recognized by its red, macerated thin plaques with satellite
papules
Topical nystatin cream is the first-line therapy in treating diaper candidiasis.
first-line therapy for the treatment of mild to moderate acne vulgaris? Topical retinoids
They should be used over the entire involved area to prevent new comedone formation rather than
applied as "spot treatment" only to existing lesions.
Use of bactericidal soap is sometimes used as an adjuvant to topical retinoid therapy
, Juvenile rheumatoid arthritis most appropriate screening test? A slit-lamp examination allows for
high magnification viewing of the anterior chamber and can detect subtle signs of intraocular
inflammation
Enchondroma benign bone tumor that often occurs in the metacarpals and phalanges of the
fingers
treated with observation alone
OIiier disease & Maffucci syndrome multiple enchondromas that may present in a single
extremity
multiple enchondromas and soft tissue angiomas.
Giant cell tumor of bone nonmalignant but is aggressive and may invade local structures
often arises in the distal femur
Histologically, it contain giant cells and mononuclear stromal cells. The presence of a spiculated lung
lesion makes metastatic lung cancer a more likely diagnosis.
Osteosarcoma most common type of primary bone cancer and occurs frequently above the knee
in the distal femur or below the knee in the proximal tibia.
initial presentation often includes pain and swelling; sometimes, a fragility fracture is the declaring
presentation. It is most common in patients under 30 years of age.
Destructive bone lesions in adults are most commonly the result of metastatic disease rather
than a primary bone malignancy. Cancers that commonly metastasize to bone include lung, breast,
thyroid, kidney, and prostate cancer.
