NBME CBSE Form 6 Latest Version Actual Exams and Study Guides (3 Versions) ( Questions and Answers)

21 yo female college student acne x 4 days concerned about appearance because wedding in 3 weeks Obj - acute acne over face with predominance of comedones and pustules Initial step in tx? ---------- Correct Answer --------- Topical retinoic acid Acne vulgaris: Usually a self-limited disorder of teenagers and young adults. Comedones (small cyst formed in hair follicle) are clinical hallmark; often accompanied by inflammatory lesions of Papules, Pustules, or Nodules. May scar in severe cases. Tx Mild acne: Use topicals alone. Benzoyl peroxide, Retinoic Acid, Erythromycin, or Clindamycin, and Antiseptics. PO oral tx Use in moderate to severe cases (cystic acne). Oral tetracyclines (doxycycline), erythromycin, clindamycin. Isotretinoin in very severe cases 42 yo woman right sided abdominal cramps and nausea and scleral icterus underwent laparoscopic cholecystectomy 2 months ago no intraoperative cholangiography was done Obj - scleral icterus, mild RUQ tenderness total bilirubin 8, direct bili 5, alk phos 650 US abdomen - dilation of intrahepatic biliary ducts Next step? ---------- Correct Answer --------- Endoscopic retrograde cholangiopancreatography Cholangiography is definitive test for cholangitis (infection of biliary tract leading to biliary stasis and bacterial overgrowth). Do not perform during acute phase of illness. Tx = IV antibiotics and IVF. Cholangitis - Charcot triad (RUQ pain, jaundice, fever), Reynold's pentad (Charcot + septic shock and AMS) 47 yo man threatening harm to radio announcer multiple psych hospitalizations over past 20 years for similar delusions past symptoms improved with neuroleptic therapy but he stopped taking htem Most appropriate pharm to decrease risk for future hospitalization? ---------- Correct Answer --------- Haloperidol Haloperidol decanoate for non-compliant patients. 26 yo woman marked confusion x 2 hours had flu-like illness for 3 days past 6 weeks, had increased fatigue, weakness, nausea recently started thyroid hormone replacement for autoimmune thyroiditis T 100.4F, BP 80/40, HR 140 Obj - cool, mottled skin; generalized hyperpigmentation (especially palmar creases) Labs - anemia, eosinophilia, hyponatremia, low chloride, hyperkalemia ECG - sinus tachy with peaked T waves What will confirm the primary cause of this condition? ---------- Correct Answer --------- ACTH stimulation test First check cortisol level, then ACTH level. Confirm primary adrenal insufficiency (Addison's) with ACTH test. ACTH test = IV infusion of synthetic ACTH and measure plasma cortisol; in primary adrenal insufficiency, cortisol does not increase sufficiently. Tx = daily oral glucocorticoid and daily fludrocortisone 19 yo man single, large stab wound in RUQ 45 mins ago Obj - obtunded, BP 60/palpable, HR 148, breath sounds equal bilaterally, 4cm laceration in RUQ in midclavicular line, abdomen distended Next step? ---------- Correct Answer --------- Laparotomy Unstable patient; no need to do diagnostic tests; go straight to operation room as hemorrhage is going on and can result in irreversible shock 16 yo high school wrestler rash on forearms and back of legs x 1 week patient is allergic to pollen and dust Obj - patches of erythema with mild lichenification over antecubital and popliteal fossae, clusters of painful umbilicated vesciles at sites of active skin inflammation Dx? ---------- Correct Answer --------- Eczema herpeticum Always suspect a herpes infection with the finding of "vesicles on erythematous base" for example zona is also like this or herpes gingivitis. Eczema herpeticum is also called herpes gladiatorium and is common among wrestlers. Eczema herpeticum, also known as a form of Kaposi varicelliform eruption caused by viral infection, usually with the herpes simplex virus, is an extensive cutaneous vesicular eruption that arises from pre-existing skin disease, usually atopic dermatitis. 3 yo boy follow-up exam completed 10 days of amoxicillin right ear pain not resolved Obj - irritable, T 102F, downward and lateral displacement of right auricle with tenderness to palpation of posterior auricular area Next step? ---------- Correct Answer --------- CT head The child had acute otitis media that has most likely progressed to mastoiditis. The CT scan would do a good job of evaluating if he has developed a brain abscess and would also do a reasonable job of looking at the mastoid air cells. 6 month old girl routine health maintenance exam born with lumbosacral myelomeningocele which was repaired at 2 days of age head is enlarging each month severe motor and sensory deficits in both lower extremities Cause of ICP? ---------- Correct Answer --------- Obstruction of CSF flow Diagnosis is Arnold chiari malformation type II which has 100% association with lumbar myelomeningocele. 90% of patients with AC malformation type II will have obstructive hydrocephalus d/t aqueductal stenosis. 72 yo man chronic abdominal pain and HA x 4 months more forgetful in past 6 months hx of gout, smokes 1 ppd x 50 years, drinks 10 oz homemade whiskey daily Obj - BP 160/98, HR 74, RR 16, mild short-term memory loss, decreased sensation to pinprick in distal extremities, ataxic gout Labs - anemia, creatinine 2, high uric acid 3YO boy has recurrent S. aureus abscesses and pneumonia. uncle had similar disease. mechanism for recurrent infections? --------- Correct Answer --------- impaired phagocytic oxidative metabolism (CGD - X-linked) Why do menopausal women get decreased libido? --------- Correct Answer --------- low androgens MC cause of RUQ bruit for smoker with HTN? --------- Correct Answer --------- atherosclerosis - accumulation of lipids site of lesion causing pain in forearm and pinky, with grip weakness and decreased sensation to light touch? --------- Correct Answer --------- ulnar nerve at elbow dx of enlarged rubbery prostate in male with hesitancy and frequency, leuks and G- rods on urinalysis? --------- Correct Answer --------- BPH dx of kid with 2 week history of shallow respirations, right effusion, chest pain and hilar adenopathy after going to Albania 6 months ago? --------- Correct Answer --------- TB dx of lady one day off warfarin with pain and vomiting, voluntary guarding but exam is unremarkable besides Hgb 7.3? --------- Correct Answer --------- intramural hematoma of small bowel - think blood loss but FOBT was negative stroke location for IPSI horner's and weakness of palate, incoordination IPSI, and CL extremity loss of sensation? --------- Correct Answer --------- IPSI vertebral artery dx of murmur in baby with respiratory tract infections, to-and-fro murmur, loud S2 and widened pulse pressure? --------- Correct Answer --------- PDA describe mitral stenosis murmur. what is increased in this pt? --------- Correct Answer --------- opening snap/sound after S2 with rumbling late diastolic murmur, has increased pulmonary artery pressure pt on peritoneal dialysis has abd pain with fever, distension, leukocytosis. what to do next? --------- Correct Answer --------- paracentesis - check G stain of abdominal fluid 2 month old does not laugh or squeal and cannot reach for toys. is this normal? --------- Correct Answer --------- yes sounds like dementia but was previously treated successfully. what dx to consider? --------- Correct Answer --------- MDD - memory loss, insomnia, low appetite all cover both big dude has elevated BGL, urinary frequency and weight loss. dx? --------- Correct Answer --------- DM2, has insulin resistance with elevated serum insulin what is seen on urinalysis in kid who is seriously dehydrated with minimal UOP? --------- Correct Answer --------- hyaline casts - urine is super concentrated dx of 3MO with generalized hypotonia, cardiomegaly and hepatomegaly? --------- Correct Answer --------- Pompe disease old person gets pneumonia after viral illness, previously had PNA months ago. why they keep doing this? --------- Correct Answer --------- bad gag reflex - aspiration no breath sounds and opacification of hemithorax after MVC dx? --------- Correct Answer --------- hemothorax dx of severe low back pain with diaphoresis, hemodynamic instability, calcifications anterior to vertebral bodies? --------- Correct Answer --------- Ruptured AAA dx of 60YOF who has crampy abd pain and diarrhea moreso with dairy? type of diarrhea? --------- Correct Answer --------- lactose intol - malabsorptive with osmotic diarrhea dude with mech aortic valve is infected/septic. has hemiparesis without nuchal rigidity. what to get worried about? --------- Correct Answer --------- brain abscess how to help a 15 YOF be compliant with medication? --------- Correct Answer --------- negotiate a contract