NBME complete exam latest
questions and answers for
2023 new review material
25 yo F at 27 weeks w/ severe contractions x6 hours, vaginal spotting, contractions
every 2-3 mins w/ FHR 130 and no decels, cervic 1-2 cm and 70% effaced, GBS is
positive. next step? - IM beclamethasone THEN later can give penicillin
man w/ 15 yr hx of difficult relaxing hands after tightly gripping objects or shaking hands,
difficulty releasing after gripping w/ hands. dx? - myotonic muscular dystrophy
pt unable to see out of R eye since awakening 2 hrs ago. visual acuity 20/200 in R eye
and 20/20 in L. R pupil poorly reactive to light. where is site of lesion? - R optic nerve
6 mo old w/ poor feeding, labored breathing, to and fro murmur in 2nd L itnercostal
space, loud S2, bounding peripheral pulses, widened pulse pressure. dx? - patent
ductus arteriosus
recurrent lymph node infxns w/ staph a in a kid. what is dx and mechanism? - chronic
granulomatous dz --> impaired phagocytic oxidative metabolism
pt hyperkalemic bc missed 2 dialysis appointments. EKG w/ peaked t waves. next step?
- IV calcium gluconate --> THEN can give insulin but this works within minutes
hyaline casts vs WBC casts? - -WBC casts: interstitial nephritis and pyelonephritis
-hyaline casts: AKI
4 yo M in MVC, RR 32 w/ grunting and restractions, hypoxic on ABG, CXR 4 hrs later
shows diffuse infiltrates on R side. dx? - pulmonary contusion
asymptomatic 57 yo M smoker, bruit in RUQ, no masses, BUN 23, Cr 1.4. what is cause
of bruit? - accumulation of lipids in arterial wall --> renal artery stenosis
52 yo F w/ decreased libido, underwent TAH and bilateral salpingo-oophorectomy for
leiomyomata uteri and menorrhagia. on hormone replacement + estrogen since sx.
exam w/ moist, rugated vagina. what is cause? - decreased androgens/testosterone -->
due to oophoreectomy = decreased androstenedione and DHEA = aka
hypergonadotropic hypogonadism ant pituitary works ovaries don't
, 67 yo F w/ afib on warfarin, INR 6 so meds stopped, next day she had abdominal pain
and vomiting x24 hours, Hgb 13 --> 7.8. cause? - intramural hematoma of proximal
small bowel --> rare complication of warfarin
67 yo M w/ 1 hours of vertigo, nausea, imbalance, small R pupil, mild R ptosis,
nystagmus, weakness of R palate, sensation to pinprick is decreased over R face and L
extremities + incoordination of finger to nose and heel-shin. where is occlusion? - R
vertebral
77 yo F w/ cramping abdominal pain and distention w/ n/v. no hx of abdominal sx.
afebrile, tachy. distended abdomen w/ mild diffuse tenderness. BS are high pitched. x-
ray of abdomen shows air fluid levels in SB and liver but no gas in colon or free air. dx?
- gallstone ileus --> air in billiary tree/liver even though all other signs sound like SBO
18 mo old has not used L arm since he fell while walking & holding hands w/ sister. he
is holding LUE at side w/ forearm pronated. no tenderness of LLE, restricted movement
of elbow. next step? - passive hypersupination of forearm --> nurse maid elbow aka
radial head dislocation (can also hyperpronate)
asthmatic teen w/ asthma attack, she hast not been taking her meds. what is best way
to get her to be compliant - negotiate a contract regarding med compliance
5 mo old w/ persistent wheezing since birth, well-nourished, wheezing w/ extension of
neck. what is cause? - compression of airway by vascular ring --> malformation of aorta
so wraps around trachea, improves w/ neck extension --> sx
*largyngomalacia improves in prone position not extension*
heavy cigarette smoker w/ hiccups. Na+ 120. CXR w/ R hilar mass. next step? - fluid
restriction --> SIADH from small cell lung CA
female w/ herberden's nodes, generalized weakness x2 weeks. BUN 41 and Cr 4. what
is cause? - ATN --> from chronic NSAIDs
32 yo F brought to ED after MVC, agitated, SOB, tachy, RR30, hypotensive, breath
sounds absent on R, L sounds normal, CXR w/ opacification of R hemithorax. cause? -
hemothorax
IVDU w/ papilledema, LP w/ high proteins, low glucose, 200 cells. dx? - fungal
meningitis --> cryptococcal --> prolly has AIDS
52 yo F w/ difficulty sleeping through the night since son graduated HS 2 months ago
and found out he is gay, obsesses about this, feels SOB and tachy during these
episodes, worried about her son, is on leave from work. dx? - adjustment disorder w/
anxiety
*NOT PANIC DISORDER*
questions and answers for
2023 new review material
25 yo F at 27 weeks w/ severe contractions x6 hours, vaginal spotting, contractions
every 2-3 mins w/ FHR 130 and no decels, cervic 1-2 cm and 70% effaced, GBS is
positive. next step? - IM beclamethasone THEN later can give penicillin
man w/ 15 yr hx of difficult relaxing hands after tightly gripping objects or shaking hands,
difficulty releasing after gripping w/ hands. dx? - myotonic muscular dystrophy
pt unable to see out of R eye since awakening 2 hrs ago. visual acuity 20/200 in R eye
and 20/20 in L. R pupil poorly reactive to light. where is site of lesion? - R optic nerve
6 mo old w/ poor feeding, labored breathing, to and fro murmur in 2nd L itnercostal
space, loud S2, bounding peripheral pulses, widened pulse pressure. dx? - patent
ductus arteriosus
recurrent lymph node infxns w/ staph a in a kid. what is dx and mechanism? - chronic
granulomatous dz --> impaired phagocytic oxidative metabolism
pt hyperkalemic bc missed 2 dialysis appointments. EKG w/ peaked t waves. next step?
- IV calcium gluconate --> THEN can give insulin but this works within minutes
hyaline casts vs WBC casts? - -WBC casts: interstitial nephritis and pyelonephritis
-hyaline casts: AKI
4 yo M in MVC, RR 32 w/ grunting and restractions, hypoxic on ABG, CXR 4 hrs later
shows diffuse infiltrates on R side. dx? - pulmonary contusion
asymptomatic 57 yo M smoker, bruit in RUQ, no masses, BUN 23, Cr 1.4. what is cause
of bruit? - accumulation of lipids in arterial wall --> renal artery stenosis
52 yo F w/ decreased libido, underwent TAH and bilateral salpingo-oophorectomy for
leiomyomata uteri and menorrhagia. on hormone replacement + estrogen since sx.
exam w/ moist, rugated vagina. what is cause? - decreased androgens/testosterone -->
due to oophoreectomy = decreased androstenedione and DHEA = aka
hypergonadotropic hypogonadism ant pituitary works ovaries don't
, 67 yo F w/ afib on warfarin, INR 6 so meds stopped, next day she had abdominal pain
and vomiting x24 hours, Hgb 13 --> 7.8. cause? - intramural hematoma of proximal
small bowel --> rare complication of warfarin
67 yo M w/ 1 hours of vertigo, nausea, imbalance, small R pupil, mild R ptosis,
nystagmus, weakness of R palate, sensation to pinprick is decreased over R face and L
extremities + incoordination of finger to nose and heel-shin. where is occlusion? - R
vertebral
77 yo F w/ cramping abdominal pain and distention w/ n/v. no hx of abdominal sx.
afebrile, tachy. distended abdomen w/ mild diffuse tenderness. BS are high pitched. x-
ray of abdomen shows air fluid levels in SB and liver but no gas in colon or free air. dx?
- gallstone ileus --> air in billiary tree/liver even though all other signs sound like SBO
18 mo old has not used L arm since he fell while walking & holding hands w/ sister. he
is holding LUE at side w/ forearm pronated. no tenderness of LLE, restricted movement
of elbow. next step? - passive hypersupination of forearm --> nurse maid elbow aka
radial head dislocation (can also hyperpronate)
asthmatic teen w/ asthma attack, she hast not been taking her meds. what is best way
to get her to be compliant - negotiate a contract regarding med compliance
5 mo old w/ persistent wheezing since birth, well-nourished, wheezing w/ extension of
neck. what is cause? - compression of airway by vascular ring --> malformation of aorta
so wraps around trachea, improves w/ neck extension --> sx
*largyngomalacia improves in prone position not extension*
heavy cigarette smoker w/ hiccups. Na+ 120. CXR w/ R hilar mass. next step? - fluid
restriction --> SIADH from small cell lung CA
female w/ herberden's nodes, generalized weakness x2 weeks. BUN 41 and Cr 4. what
is cause? - ATN --> from chronic NSAIDs
32 yo F brought to ED after MVC, agitated, SOB, tachy, RR30, hypotensive, breath
sounds absent on R, L sounds normal, CXR w/ opacification of R hemithorax. cause? -
hemothorax
IVDU w/ papilledema, LP w/ high proteins, low glucose, 200 cells. dx? - fungal
meningitis --> cryptococcal --> prolly has AIDS
52 yo F w/ difficulty sleeping through the night since son graduated HS 2 months ago
and found out he is gay, obsesses about this, feels SOB and tachy during these
episodes, worried about her son, is on leave from work. dx? - adjustment disorder w/
anxiety
*NOT PANIC DISORDER*
