NBME CBSE Form 7 Latest Version Actual Exams and Study Guides (3 Versions) Latest Update 2023

Man unable to conceive, has ill defined soft masses palpable bilaterally, high in the scrotum. What is the most likely cause -------- Correct Answer --------- bilateral varicoceles -hydroceles don't cause infertility DIRECT inguinal hernias DO NOT ENTER THE SCROTUM 4 yo boy w/ fatigue since viral illness 3 weeks ago, gums bleeding when brushing teeth, cervical, axillary and inguinal adenopathy. hgb is 8, leukocytes are 3K and platelets are 30K. What is the next step in management-transfusion of platelets or bone marrow aspiration -------- Correct Answer --------- bone marrow aspiration patient could have a myelodysplastic syndrome, could or could not be related to the virus A 4yo boy with a 3 day history of cough, fever, runny nose is 75th percentile for height and 10th percentile for weight. vitals are normal, exam shows clear rhinorrhea, breath sounds normal. What is the diagnosis -------- Correct Answer --------- Upper respiratory infection normal to have flow murmur/splitting of S2 made louder w/ inspiration A 19 year old found standing in neighbor's living room, remains mute during questionsing. vitals are stable other than BP 160/95. Has bilateral nystagmus, constricted pupils, hypertonia, and decreased sensation to pinprick. What is the most likely substance taken -------- Correct Answer --------- PCP fluctuating behavior, autonomic disturbance (hypertension), nystagmus, hypertonia -inhalants would appear drunk w/ dilated pupils PCP apparently doesn't affect pupils. main thing is that it causes nystagmus, mutism if not aggressive 18 year old has 3 day history of fatigue and yellow eyes, family history of anemia, scleral icterus. Hgb 8.6, MCHC 38%, retic 8%, tbili 3, negative direct coombs. smear shows round RBC w/out central pallor. What would have prevented the patient's symptoms -------- Correct Answer --------- this is spherocytosis treatment/prevention of hemolytic anemia is via splenectomy! 18 year old primigravid woman admitted for labor w/ history of genital herpes, most recent outbreak 6 weeks ago. No lesions or prodromal symptoms since and no lesions on exam. Cervix 100% effaced, 5cm dilated, vertex -1. What should you do next: give acyclovir, amniotomy and vaginal delivery, or c/s -------- Correct Answer --------- amniotomy and vaginal delivery 9yo w/ low back pain for 4 months, most severe when wakes up and after physical activities. tenderness in R sacroiliac joint, paravertebral muscle spasm, decreased flexion at waste. CK normal, ESR elevated. -------- Correct Answer --------- anklylosing spondylitis...although age isn't right (mean age of onset is 23) and hard to see bamboo spine spondylolisthesis is the most common cause of back pain in teens 72 year old w/ indigestion while walking briskly or uphill, relieved by rest. Sx not related to eating and not relieved by antacids, normal exam. What test should you do next? -------- Correct Answer --------- Exercise stress test--elderly, women and diabetics have atypical presentation of angina/MI Homeless 66 year old man admitted for jaundice. Irregular eating habits, 20lb weight loss. 20 year history of alchoholism, shows signs of wasting, icteric sclerae, palmar erythema, spider angiomata. Serum Mg is 0.8. Serum studies are most likely to show what: change in calcitonin, change in calcium, change in TSH, change in Tx, or change in PTH -------- Correct Answer --------- w/ weight loss and jaundice, could have cancer. Magnesium is needed for PTH. low Mg normally stims PTH secretion but SUPERlow PTH (not an answer choice) would result in Low Calcium Previously healthy 26 year old comes to the ED for SOB and painful bumps on his anterior shins. CXR shows bilateral hilar fullness. What serum abnormality is likely in the patient -------- Correct Answer --------- THIS IS SARCOIDOSIS Pt would have hypercalcemia 47 year old w/ 6 mo history of progressive weakness beginning in R leg, spreading to other extremities. Mild difficulty swallowing solids and liquids. atrophy of R quad and both deltoids, fasciculations in both quads. Bilateral positive babinski. What would EMG and nerve conduction studies show? -------- Correct Answer --------- This patient has ALS, death of nerves w/ UMN (babinski) and LMN (fascilations) signs. EMG shows fibrillation and fasiculation potentials in multiple muscles of multiple extremities. Motor units may be polyphasic w/ high amplitude and long duration Bulbar palsy (difficulty swallowing) is common 32 year old comes w/ headache, joint pain, fever for 2 weeks. Clearly has lyme. What prevents long term complications -------- Correct Answer --------- doxycyline, AMOXICILLIN or cefuroxime pt w/ factor XI and IgA deficiencies is scheduled to undergo resection for colon cancer. Preop Hct is 24%, requires transfusion w/ units of PRBCs, then 3 minutes later gets severe SOB, utricaria w/ swelling of tongue and throut. BP 90/60. What type of transfusion reaction is thus -------- Correct Answer --------- IgA deficiency causes Anaphylactic transfusion reaction!!! 27 yo M stuck w/ needle drawn from HBV+ patient. Was vaccinated agains HBV 2 years ago, labs show adequate antihebB antibodies. What is the most appropriate management to prevent HBV? -------- Correct Answer --------- Nothing, he has antibodies that will protect him 22yo exposed to gas is vomiting w/ diarrhea, has miosis, oral secretions, rhinorrhea, muscular fasciculations, wheezing, then tonic-clonic seizure. What is the most appropriate pharmacotherapy -------- Correct Answer --------- Clearly has organophosphate poisoning treat cause: atropine. Don't need diazepam Two hours after emergency repair of a perfed gastric ulcer, a 75 year old woman has multifocal premature ventricular contractions. She has a history of CHF treated w. dig and diuretic therapy. What is the most likely serum electrolyte abnormality -------- Correct Answer --------- decreased potassium causes hypokalemia b/c competes w/ K for Na/K ATPase pump, especially in setting of diuretic use 55yo w/ known metastatis breast cancer is admitted to the hospital because of confusion progressing to obtundation over the past 24 hours. She is barely arousable. What is the most likely abnormal serum electrolyte value -------- Correct Answer --------- increased calcium (PTHrP or direct bone mets causing osteolytic release of Ca) 52 yo s/p lap chole comes w/ abd pain, nausea, decreased appetite w/ low grady fever and tachycardia. jaundice on exam, RUQ tenderness. Hgb 12.2, elevated ABC, cr 1.5, tbili 7.2, elevated alk phos and AST. US shows no fluid collections, what test should you do next? CT abdomen HIDA ERCP transhepatic cholangiography ex lap -------- Correct Answer --------- ERCP Has Charcot's triad of acute cholangitis (infection of the bile duct) fever jaundice RUQ pain after lap chole, could be from ascending infection or stone still stuck HIDA looks at gallbladder. transhepatic cholangiography done when ERCP is unsuccessful 43 yo w/ temps, L sided chest pain, malaise, loss of appetite, cough w/ yellow sputum and increasing SOB. Smoker, febrile, tachy, decreased breathsounds, increased tactile fremitus at lung base. X ray shows L lower lobe consolidation, has gram negative bacilli on gram stain. Most likely diagnosis (e. coli, h. influenzae, n. meningiditis, pseudomonas aeruginosa, strep pneumoniae) -------- Correct Answer --------- Haemophilus influenzae (gram negative coccobacillus) most common of choices in age group, other than s. pneumo which is gram positive E. coli also GN bacillus, but less likely to cause lobar PNA. lobar PNA most commonly S. pneumo (gram positive), also H. influ, klebsiella ( non-motile, Gram-negative, oxidase-negative, rod-shaped ), legionella (gram negative), mycobacterium. neisseria, pseudomonas are also gram negatives 12 month old boy w/ temps to 105 w/ two infections in the last 8 months: pneumococcal bacteremia and periorbital cellulitis from h. influenza. Had all shots. LP shows bacterial meningitis w/ GP diplococci (s. pneumo). What cell type is most likely involved in the underlying condition? -------- Correct Answer --------- B lymphocyte (X linked agammaglobulinemia These are encapsulated bacteria (SHiNE SKiS S.pneumo, H influ, Neisseria menningiditis, group B strep, klebsiella, salmonella) increased incidence of infection in pts w/ asplenia/functional asplenia and B cell disorders (antibody deficiency or opsonization defect) 12mo boy with persistent S. aureus abscess despite 2 weeks of cephalexin. 3rd infection since birth, including inguinal abscess with S. aureus, pneumonia and empyema. Cell type involved in Dx? -------- Correct Answer --------- neutrophil This patient has CGD, which has absent neutrophil respiratory burst. Affects phagocytes 5 days after an open splenectomy for ITP, a 57yo F has SOB. dissection of the splenic hilum was difficult during the procedure. vitals stable, breath sounds decreased at left lung base. leukocyte ct is 15,600, plt , serum amylase 90. What is the most appropriate next step in management -------- Correct Answer --------- CXR (decreased breath sounds at lung base could indicate lobar PNA vs pleural effusion) 16yo girl comatose next to a suicide note. Unresponsive. Temp 37.2C, p 100/min, resp 28/min, BP 100/66. Pupils reactive to light; doll's eye reflex present. Labs: Na 140, Cl 104, K 3.5, HCO3 6. ABG: pH 7.32, Pco2: 12; Po2: 92. What substance had she used in her suicide attempt? -------- Correct Answer --------- Aspirin (anion gap acidosis w/ respiratory alkalosis) 72yo M for follow-up exam 4 weeks after 10-day quinolone Rx for UTI. Has been drinking 12 to 15 glasses of water daily to prevent another infection. 30-year hx of schizoaffective d/o. On Reisperidone. Oriented to person but not to place or time. P 80/min, BP 128/60, with no orthostatic changes. Exam shows dry oral mucosa and no JVD. Lungs clear. No peripherla edema. Muscle strength 5/5, sensation intact. Reflexes 1+ bilaterally. Labs: Na 122, K 4, Cl 94, HCO3 22, BUN 16, Cr 1.1; Urine: blood neg, glucose neg, protein neg, sodium 20, osmolality 200. Cause of hyponatremia? -------- Correct Answer --------- psychogenic polydypsia (drinking too much water because worried about UTI, pt has history of psych disorder) 42yo M scheduled to undergo MRI for hemoptysis and abnormal CXR. During MRI, he yells to get out, and appears pale. No chest pain or SOB, but had tunnel vision and tingling in his fingers while in the machine. Hx of hypothryroidism Rx with levothyroxine and occasional heartburn rx with rantidine. P 104/min, resp 22/min and shallow, BP 140/09. No evidence of paranoia. Most appropriate next step in management? biofeedback, TSH, breathe into paper bag, hypnosis, haloperidol, lorazepam, propanolol -------- Correct Answer --------- Lorazepam for anxiety Esophageal peristalsis and LES spincter tone are increased or decreased in achalasia? -------- Correct Answer --------- esophageal peristalsis decreased (aperistalsis from dilation of esophagus), LES tone increased