Peds NBME Form 1 UPDATED ACTUAL and Correct Answers
Question: Pt - dec energy; cold intolerance
Thyroid - patchy and irregular uptake of radioisotopes
T4 dec
TSH inc
biopsy of thyroid will show?
Answer:
lymphocytic infiltration
MC cause of hypoT = Hashimoto's
caused by lymphocytic infiltration
antibodies (antiT peroxidase and antithyroglobulin)
Question: Normal menses
Smokes
pack of cigs daily for 3 yrs; drinks 1 oz of alc weekly
50 yo mom - dx w/ breast cancer 1 yr ago
dad and grandpa died of heart dz during their 30s
BP is
mmHg while sitting
next screening test?
Answer:
serum lipid studies
Question: FHx
Answer:
premature CAD, HTN, HLD
BMI: 35
RR: 24/min
BP:
mmHg
Inc chol, LDL, triG
Dec HDL
next step in mgnt?: reduced-calorie diet
most correct answers: diet > exercise and adherence (meds/lifestyle)
,Question: 13 yo girl
6-wk hx of constant abd pressure, breast tenderness, and weight gain
no period
Tanner stage 3
PE: nontender mass below umbilicus
next step in dx?
Answer:
measure serum B-hCG conc
best 1st step in r/o amenorrhea
you wanna r/o pregnancy - even if the pt has never had a period before
Question: 14 yo girl
monthly lower abd pain during the past 6 months
Tanner stage 4
PE
Answer:
suprapubic tenderness; no masses; bluish red smooth bulge between
labia
next step in mgnt?: cruciate incision of hymen
bc it's an imperforate hymen
Question: 16 yo boy
facial rash for 2 wks - started on chin > spread over face
dx?
Answer:
impetigo contagiosa
Question: 16 yo boy
testes descended BL
painless mass in scrotum - "milked" into abd through inguinal ring
dx?
Answer:
inguinal hernia
more obvious when you're upright
this is indirect bc it went through the ring
can cause bowel obstruction if moves into the abd and becomes swollen
, Question: 4 day old female
delivery required vacuum extraction
breast feeding w/ normal stool and urine output
large cephalhematoma, scleral icterus, and jaundice of lower ext
Coombs test neg
serum total BR = 20.8
next step in mgnt?: phototherapy
indirect hyperBR requires immediate therapy to prevent kernicterus (when BR > 20-25)
can start workup w/ Coombs test, Hgb, and retic count to find the cause
most likely cause in this baby
Answer:
cephalhematoma
Question: 5 yo boy - inc fatigue for 3 wks; acute onset of fever and chills 2 hrs ago
1 month ago - Asia; received chloroquine ppx
PE: pallor and splenomegaly
low Hct, platelets
inc leukocytes
next step in dx?: thick and thin blood smears
kid most likely has G6PD deficiency
oxidant stress: drugs (dapsone, primaquine, CHLOROQUINE), infection, DKA, or fava beans
smear will show Heinz bodies and bite cells
confirm dx
Answer:
G6PD level - but wks after attack
Question: 2 month old boy
3 day hx of vomiting - inc in amount/force
cow milk-based formula - vomits after every feeding
non bloody, nonbilious undigested formula
mildly dehydrated
CMP: low Na, Cl; high HCO3-
most likely dx?: pyloric stenosis
typical presentation of baby 2-8 wks of age suddenly developing projectile vomiting after feeds
PE: olive-shaped mass; visible peristaltic waves
CMP: hypochloremic, hypokalemic, met alkalosis - requires immediate IVF
*remember to fix electrolytes before surgery (pyloromyotomy)!*
Question: Pt - dec energy; cold intolerance
Thyroid - patchy and irregular uptake of radioisotopes
T4 dec
TSH inc
biopsy of thyroid will show?
Answer:
lymphocytic infiltration
MC cause of hypoT = Hashimoto's
caused by lymphocytic infiltration
antibodies (antiT peroxidase and antithyroglobulin)
Question: Normal menses
Smokes
pack of cigs daily for 3 yrs; drinks 1 oz of alc weekly
50 yo mom - dx w/ breast cancer 1 yr ago
dad and grandpa died of heart dz during their 30s
BP is
mmHg while sitting
next screening test?
Answer:
serum lipid studies
Question: FHx
Answer:
premature CAD, HTN, HLD
BMI: 35
RR: 24/min
BP:
mmHg
Inc chol, LDL, triG
Dec HDL
next step in mgnt?: reduced-calorie diet
most correct answers: diet > exercise and adherence (meds/lifestyle)
,Question: 13 yo girl
6-wk hx of constant abd pressure, breast tenderness, and weight gain
no period
Tanner stage 3
PE: nontender mass below umbilicus
next step in dx?
Answer:
measure serum B-hCG conc
best 1st step in r/o amenorrhea
you wanna r/o pregnancy - even if the pt has never had a period before
Question: 14 yo girl
monthly lower abd pain during the past 6 months
Tanner stage 4
PE
Answer:
suprapubic tenderness; no masses; bluish red smooth bulge between
labia
next step in mgnt?: cruciate incision of hymen
bc it's an imperforate hymen
Question: 16 yo boy
facial rash for 2 wks - started on chin > spread over face
dx?
Answer:
impetigo contagiosa
Question: 16 yo boy
testes descended BL
painless mass in scrotum - "milked" into abd through inguinal ring
dx?
Answer:
inguinal hernia
more obvious when you're upright
this is indirect bc it went through the ring
can cause bowel obstruction if moves into the abd and becomes swollen
, Question: 4 day old female
delivery required vacuum extraction
breast feeding w/ normal stool and urine output
large cephalhematoma, scleral icterus, and jaundice of lower ext
Coombs test neg
serum total BR = 20.8
next step in mgnt?: phototherapy
indirect hyperBR requires immediate therapy to prevent kernicterus (when BR > 20-25)
can start workup w/ Coombs test, Hgb, and retic count to find the cause
most likely cause in this baby
Answer:
cephalhematoma
Question: 5 yo boy - inc fatigue for 3 wks; acute onset of fever and chills 2 hrs ago
1 month ago - Asia; received chloroquine ppx
PE: pallor and splenomegaly
low Hct, platelets
inc leukocytes
next step in dx?: thick and thin blood smears
kid most likely has G6PD deficiency
oxidant stress: drugs (dapsone, primaquine, CHLOROQUINE), infection, DKA, or fava beans
smear will show Heinz bodies and bite cells
confirm dx
Answer:
G6PD level - but wks after attack
Question: 2 month old boy
3 day hx of vomiting - inc in amount/force
cow milk-based formula - vomits after every feeding
non bloody, nonbilious undigested formula
mildly dehydrated
CMP: low Na, Cl; high HCO3-
most likely dx?: pyloric stenosis
typical presentation of baby 2-8 wks of age suddenly developing projectile vomiting after feeds
PE: olive-shaped mass; visible peristaltic waves
CMP: hypochloremic, hypokalemic, met alkalosis - requires immediate IVF
*remember to fix electrolytes before surgery (pyloromyotomy)!*
