NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS LATEST .with verified QUESTIONS AND ANSWERS GRADED A+.

NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS LATEST verified QUESTIONS AND ANSWERS GRADED A+. Why it’s right: The question is asking about the most common causes of occult blood in an older patient. Occult here means it’s occult or “stealthy,” and you can’t see it with the naked eye – a fecal occult blood test has to be done to find it. Occult blood contrasts with overt blood, which you can “overtly” see in the stool. The most common causes of occult blood in an older patient are diverticulosis and angiodysplasia. Both of these causes are relatively benign. This question is made a bit more difficult because it wants you to identify a malignancy precursor. This is the reason FOBTs and colonoscopies are used in screening for colon cancer – the most common GI tumor and one of the most common cancers in general. Because this patient is 70 and has blood in his stool, the most likely malignant precursor is a tubular adenoma, a benign lesion but a precursor to adenocarcinoma of the colon. Take home point: The most common causes of benign, occult GI bleeding in older patients are diverticulitis and angiodysplasia; the most common cause of pre-malignant, occult GI bleeding is a tubular adenoma. Why it’s right: The diagnosis is hay fever. The only extra history that is missing is the time of year – spring or fall when seasonal allergies are at their peak. Even if the diagnosis seems like a common cold, there is no congestion or lower lung involvement. The treatment of choice is a histamine antagonist since the chemical mediator of hay fever/seasonal allergies is histamine. Loratadine is a histamine antagonist. Take home point: Treatment for hay fever is histamine inhibition with a histamine antagonist such as loratadine. Why it’s right: The diagnosis is infectious mononucleosis. The real USMLE will not give such an obvious age – a teenager, which is a common age for contraction because mono is also known as kissing disease. Symptoms include general flu- like symptoms – fever, cough, fatigue. The ultimate clue here would be if they included an enlarged spleen on physical exam. Sometimes, not always, mono can cause a hemolytic anemia due to the circulating immune complexes IgM against the virus that then cross react with the patient’s blood cells, triggering agglutination and hemolysis. For this reason, the patient has pale conjunctiva, a tell-tale sign of anemia. Take home point: Infectious mononucleosis can cause a hemolytic anemia through IgM-activated hemolytic agglutination. Why it’s right: For sexually transmitted infections, the first question that should be asked is, pain or painless? That narrows the diagnosis down by 50%. A second question to ask is, multiple or single lesions? That narrows it down by another 50%. If we apply this method to this question, we know this is a painful lesion, so the top of the differential is herpes and chancroid. This patient has multiple lesions (small tender blisters). Herpes appears as multiple blisters while chancroid generally presents as a single lesion. If the lesion was painless, that would narrow the differential to syphilis and genital warts. And syphilis is a single lesion while genital warts present as multiple lesions. Take home point: HSV2 is a painful, multiple-lesion disease presenting as small, tender blisters in clusters.