NBME PEDs 1 and 2 NBME MASTERY,
(Answered) Complete Solution
17yo girl brought to ED after found lying on the street. Outside temp is 40F. En
route to hospital, paramedics administered O2 and ECG showed J-wave. She is
lethargic and poorly responsive to verbal commands. Temp is 32 (89.6F). Puls =
60, RR = 12, BP = 90/60. There is an odor of ethanol on her breath. Which of the
following is most likely explanation for the patient's cardiac findings?
a. cocaine toxicity
b. ethanol toxicity
c. hyperkalemia
d. hypocalcemia
e. hypothermia
f. increased intracranial pressure
g. MI
e. hypothermia (J wave = hypothermia)
A 3 yr old comes to the ED after an episode of syncope followed by a tonic-clonic
seizure. She becomes fully alert, then stops talking, closes her eyes, and has 3-4
rhythmic jerks of her arm. During this second episode, an ECG was recorded that
showed P waves at 80/min with no QRS complexes. NSR resumes shortly
thereafter. She becomes alert one minute after. Most likely diagnosis?
A) Absence seizure
B) Adams-Stokes attack
C) Adverse effect of medication
D) Breath-holding episode
E) Carotid artery trauma
F) Narcolepsy-cataplexy
G) Vasovagal episode
H) Ventricular tachyarrhythmia
B) Adams-Stokes attack
cause of recurrent infection
impaired humoral immunity
mixed metabolic acidosis and resp alkalosis
salicylate poisoning
patchy irregular uptake of radioisotope
Multinodular goiter
What is anotehr name for multinodular goiter
lymphocytic thyroiditis/ infiltration
14 day feevr headache and green nasal discharge in a 14 yr old kid. Post
pharyngeal wall is erythematous and covered with thin gray mucous
Sinusitis
SCID has an abscence of what cells
T cells - leads to B cell impairment too. Both are low
,recurrent infection - bacterial, fungal and viral
SCID
Pt has foreign body, next step
bronchoscopy - take it out
kid has fever and right foot pain. itching rash stared between the second and
third toes of both feel. PLays sports in highschool. Lymphnode in groin is tender
Pseudomonas - becasue he has fever.
Keep in mind that athletes foot, Trichophyton rubrum is a fungus that most common
cause of athletes foot, jock itch and ringworm but IT DOES NOT HAVE FEVER or
TENDER LYMPH NODE
2 days after delivery a male newborn has dribbling. on PE he has a 6 cm round
midline suprapubic pelvic mass
Posterior urethral valves
Hep A ab +
Hep B core Ab +
Hep B surface ag +
Hep B surface ab -
Hep A virus - immune
Hep B virus - not immune
2 yr olld boy with anorexia poor coordination and sporadic vomiting over teh last
month. Lab shows hypochromic microcytic anemia.
lead poisoning (not iron def)
ashleaf spots - Skin hypopigmentation, four periventricular nodules - cortical
tubers
Tuberous sclerosis
what can TMPSMX cause on labs
neutropenia** ( low segmented neutrophils)
14 yr old girl pt with suprapubic tenderness for 6 mo. She has a red smooth bulge
between the labia. Next step?
impreforate hymen - do cruciate incision of the hymen
pt with anorexia is at risk for what bone morphology?
osteoporosis
A low pitched vibratory murmur is heard through the cardiac cycle and is most
prominent at the left upper sternal border when the child is in the sitting position.
The murmur dissapears when his neck is rotated in the sitting position
Venous hymm - when he turns his head left it cuts it off. Venous hum is when he blood
goes through the internal jugular vein
5 ear old with fatigue for 3 weeks, acute onset of fever and chills for 2 hours.
Traveled to asia 1 month ago and received chloroquine. Exam shows pallor and
splenomegaly. HCT 22, leuko 18, platelets 80.
assay for strep
assay for heterophile
measure PT and PTT
, Measure AST and ALT
thick and thin blood smears
thick and thin blood smears: to look for look at blood for heinz bodies and bite cells
14 yr old girl with downs is evaluated for polycythemia vera. she has cyanosis
and clubbing. There is an S2 increased in intensity. she has a large ventricular
septal defect and a dilated main pulmonary artery. What is causing the
polycythemia?
Pulmonary artery HTN
fundoscopic examination shows an abscence of venous pulsations
increased intercranial pressure, papillemdema, cerebral edema etc.
A 5lb 5 oz newborn is delivered at 37 weeks gestation to a 32 year old women,
gravida 1 para 1, following an uncomplicated delivery. The mom has history of IV
drug use and received no prenatal care. She did not take any med during
pregnancy. Rapid HIV testing of the mother after delivery is positive. Exam of
newborn shows no abnormalities. Which of the following is the best next step to
manage the newborn?
A) A 6-week course of oral AZT beginning at the 2 week exam
B) A 6-week course of oral AZT only if CD4 count decreases to less than 200/mm
C) A 6-week course of oral AZT within 12 hours after delivery
D) A 6-week course of triple antiretroviral therapy beginning at the 2 week exam
E) A 6-week course of triple antiretroviral therapy if the CD4 T count decrease to
less than 200/mm
F) A 6-week course of triple antiretroviral therapy within 24 hours after delivery
C) A 6-week course of oral AZT within 12 hours after delivery
"click" or more precisely "clunk" in the hip may be detected. Ortolani maneuver
and the Barlow maneuver
main types are the result of either laxity of the supporting capsule or an abnormal
acetabulum.
"developmental dysplasia of the hip" (DDH) to "congenital dislocation of the hip" (CDH)-
include subluxation, dysplasia, and dislocation
U/S until 3 mo - then can do xray. xray cant visualize calcification
16 yr boy old with a painless lump in is right breast. 1cm smooth firm mass under
right nipple. no nipple or skin retraction or lymphadenopathy
Physiologic pubertal development
diarrhea with chicken
salmonella - cook meat properly
An 18-month-old boy is brought to the physician because of diarrhea for 3 days.
He attends day care, and several other children at the center have similar
symptoms. The water source for the day-care center is a private well. The center
has a pet turtle and two canaries. The patient's temperature is 37.7°C (99.9°F). He
is well hydrated. The remainder of the examination shows no abnormalities.
Examination of the stool for ova and parasites is negative. A stool culture grows
no enteric pathogens. Rotavirus testing is positive.
(Answered) Complete Solution
17yo girl brought to ED after found lying on the street. Outside temp is 40F. En
route to hospital, paramedics administered O2 and ECG showed J-wave. She is
lethargic and poorly responsive to verbal commands. Temp is 32 (89.6F). Puls =
60, RR = 12, BP = 90/60. There is an odor of ethanol on her breath. Which of the
following is most likely explanation for the patient's cardiac findings?
a. cocaine toxicity
b. ethanol toxicity
c. hyperkalemia
d. hypocalcemia
e. hypothermia
f. increased intracranial pressure
g. MI
e. hypothermia (J wave = hypothermia)
A 3 yr old comes to the ED after an episode of syncope followed by a tonic-clonic
seizure. She becomes fully alert, then stops talking, closes her eyes, and has 3-4
rhythmic jerks of her arm. During this second episode, an ECG was recorded that
showed P waves at 80/min with no QRS complexes. NSR resumes shortly
thereafter. She becomes alert one minute after. Most likely diagnosis?
A) Absence seizure
B) Adams-Stokes attack
C) Adverse effect of medication
D) Breath-holding episode
E) Carotid artery trauma
F) Narcolepsy-cataplexy
G) Vasovagal episode
H) Ventricular tachyarrhythmia
B) Adams-Stokes attack
cause of recurrent infection
impaired humoral immunity
mixed metabolic acidosis and resp alkalosis
salicylate poisoning
patchy irregular uptake of radioisotope
Multinodular goiter
What is anotehr name for multinodular goiter
lymphocytic thyroiditis/ infiltration
14 day feevr headache and green nasal discharge in a 14 yr old kid. Post
pharyngeal wall is erythematous and covered with thin gray mucous
Sinusitis
SCID has an abscence of what cells
T cells - leads to B cell impairment too. Both are low
,recurrent infection - bacterial, fungal and viral
SCID
Pt has foreign body, next step
bronchoscopy - take it out
kid has fever and right foot pain. itching rash stared between the second and
third toes of both feel. PLays sports in highschool. Lymphnode in groin is tender
Pseudomonas - becasue he has fever.
Keep in mind that athletes foot, Trichophyton rubrum is a fungus that most common
cause of athletes foot, jock itch and ringworm but IT DOES NOT HAVE FEVER or
TENDER LYMPH NODE
2 days after delivery a male newborn has dribbling. on PE he has a 6 cm round
midline suprapubic pelvic mass
Posterior urethral valves
Hep A ab +
Hep B core Ab +
Hep B surface ag +
Hep B surface ab -
Hep A virus - immune
Hep B virus - not immune
2 yr olld boy with anorexia poor coordination and sporadic vomiting over teh last
month. Lab shows hypochromic microcytic anemia.
lead poisoning (not iron def)
ashleaf spots - Skin hypopigmentation, four periventricular nodules - cortical
tubers
Tuberous sclerosis
what can TMPSMX cause on labs
neutropenia** ( low segmented neutrophils)
14 yr old girl pt with suprapubic tenderness for 6 mo. She has a red smooth bulge
between the labia. Next step?
impreforate hymen - do cruciate incision of the hymen
pt with anorexia is at risk for what bone morphology?
osteoporosis
A low pitched vibratory murmur is heard through the cardiac cycle and is most
prominent at the left upper sternal border when the child is in the sitting position.
The murmur dissapears when his neck is rotated in the sitting position
Venous hymm - when he turns his head left it cuts it off. Venous hum is when he blood
goes through the internal jugular vein
5 ear old with fatigue for 3 weeks, acute onset of fever and chills for 2 hours.
Traveled to asia 1 month ago and received chloroquine. Exam shows pallor and
splenomegaly. HCT 22, leuko 18, platelets 80.
assay for strep
assay for heterophile
measure PT and PTT
, Measure AST and ALT
thick and thin blood smears
thick and thin blood smears: to look for look at blood for heinz bodies and bite cells
14 yr old girl with downs is evaluated for polycythemia vera. she has cyanosis
and clubbing. There is an S2 increased in intensity. she has a large ventricular
septal defect and a dilated main pulmonary artery. What is causing the
polycythemia?
Pulmonary artery HTN
fundoscopic examination shows an abscence of venous pulsations
increased intercranial pressure, papillemdema, cerebral edema etc.
A 5lb 5 oz newborn is delivered at 37 weeks gestation to a 32 year old women,
gravida 1 para 1, following an uncomplicated delivery. The mom has history of IV
drug use and received no prenatal care. She did not take any med during
pregnancy. Rapid HIV testing of the mother after delivery is positive. Exam of
newborn shows no abnormalities. Which of the following is the best next step to
manage the newborn?
A) A 6-week course of oral AZT beginning at the 2 week exam
B) A 6-week course of oral AZT only if CD4 count decreases to less than 200/mm
C) A 6-week course of oral AZT within 12 hours after delivery
D) A 6-week course of triple antiretroviral therapy beginning at the 2 week exam
E) A 6-week course of triple antiretroviral therapy if the CD4 T count decrease to
less than 200/mm
F) A 6-week course of triple antiretroviral therapy within 24 hours after delivery
C) A 6-week course of oral AZT within 12 hours after delivery
"click" or more precisely "clunk" in the hip may be detected. Ortolani maneuver
and the Barlow maneuver
main types are the result of either laxity of the supporting capsule or an abnormal
acetabulum.
"developmental dysplasia of the hip" (DDH) to "congenital dislocation of the hip" (CDH)-
include subluxation, dysplasia, and dislocation
U/S until 3 mo - then can do xray. xray cant visualize calcification
16 yr boy old with a painless lump in is right breast. 1cm smooth firm mass under
right nipple. no nipple or skin retraction or lymphadenopathy
Physiologic pubertal development
diarrhea with chicken
salmonella - cook meat properly
An 18-month-old boy is brought to the physician because of diarrhea for 3 days.
He attends day care, and several other children at the center have similar
symptoms. The water source for the day-care center is a private well. The center
has a pet turtle and two canaries. The patient's temperature is 37.7°C (99.9°F). He
is well hydrated. The remainder of the examination shows no abnormalities.
Examination of the stool for ova and parasites is negative. A stool culture grows
no enteric pathogens. Rotavirus testing is positive.
