NBME 6 STUDY QUESTION AND
ANSWERS 2024/2025
11. A 67-year-old woman is hospitalized because of abdominal pain and persistent copious vomiting for
24 hours. Two weeks ago, she was hospitalized for treatment of atrial fibrillation; after cardioversion to
a normal sinus rhythm, she began treatment with warfarin. Yesterday at a follow-up visit, her INR was 6,
and her medication was discontinued. She takes no other medications. Her temperature is 37 C (98.6 F),
blood pressure is 100/78 mm Hg, pulse is 120/min and regular, and respirations are 20/min. The
abdomen is distended and moderately tender; there is voluntary guarding in the epigastrium. There are
no masses, organomegaly, or obvious hernias. Rectal examination shows no abnormalities. Test of the
stool for occult blood is negative. Her hemoglobin level has decreased from 13 g/dL yesterday to 7.8
g/dL today. An ECG shows a normal sinus rhythm. Which of the following is the most likely explanation
for this pati✔ ✔ C) Intramural hematoma of the proximal small bowel
is the correct answer ,
It is a case of warfarin toxicity which resulted in hematoma formation , the patient has clear signs of
bowel obstruction .
The negative Ob in the stool and significant drop in Hb can't be explained by any other answer .
33.
A 6-month-old girl is brought to the physician because of poor feeding and labored breathing for 2
months. She has had recurrent respiratory tract infections since birth. Examination shows a to-and-fro
murmur in the second left intercostal space, a loud S2, bounding peripheral pulses, and a widened pulse
pressure. Which of the following is the most likely diagnosis?
A) Atrial septal defect (ostium primum type)
B) Atrial septal defect (ostium secundum type)
C) Atrioventricular canal
, D) Coarctation of the aorta
E) Hypoplastic left heart syndrome
F) Patent ductus arteriosus
G) Tetralogy of Fallot
H) Transposition of the great arteries
I) Tricuspid atresia
J) Ventricular septal defect✔ ✔ Patent ductus arteriosus
PDA:
More common in girls (2:1), babies where maternal rubella infection was present, and premature
infants. Typically asymptomatic; patients with large defects may present with FTT failure to thrive,
recurrent lower respiratory tract infections, lower extremity clubbing, and CHF. Wide pulse pressure,
bounding arterial pulses, and characteristic sound of "machinery" (to-and-fro murmur)
Indomethacin-induced closure helpful in premature infants. Term infants often require surgical closure.
8. One day after an uncomplicated spontaneous vaginal delivery, a 23-year-old woman, gravida 1, para
1, has the onset of loss of small amounts of urine. She received epidural anesthesia during labor and
delivery. Examination shows an episiotomy without evidence of hematoma. She is voiding 50 to 75 mL
of urine at a time. Postvoid residual volume is 300 mL.
A ) Detrusor instability
B ) Interstitial cystitis
C ) Overflow incontinence
D ) Stress incontinence
E ) Urethra diverticulum
F ) Urinary fistula
ANSWERS 2024/2025
11. A 67-year-old woman is hospitalized because of abdominal pain and persistent copious vomiting for
24 hours. Two weeks ago, she was hospitalized for treatment of atrial fibrillation; after cardioversion to
a normal sinus rhythm, she began treatment with warfarin. Yesterday at a follow-up visit, her INR was 6,
and her medication was discontinued. She takes no other medications. Her temperature is 37 C (98.6 F),
blood pressure is 100/78 mm Hg, pulse is 120/min and regular, and respirations are 20/min. The
abdomen is distended and moderately tender; there is voluntary guarding in the epigastrium. There are
no masses, organomegaly, or obvious hernias. Rectal examination shows no abnormalities. Test of the
stool for occult blood is negative. Her hemoglobin level has decreased from 13 g/dL yesterday to 7.8
g/dL today. An ECG shows a normal sinus rhythm. Which of the following is the most likely explanation
for this pati✔ ✔ C) Intramural hematoma of the proximal small bowel
is the correct answer ,
It is a case of warfarin toxicity which resulted in hematoma formation , the patient has clear signs of
bowel obstruction .
The negative Ob in the stool and significant drop in Hb can't be explained by any other answer .
33.
A 6-month-old girl is brought to the physician because of poor feeding and labored breathing for 2
months. She has had recurrent respiratory tract infections since birth. Examination shows a to-and-fro
murmur in the second left intercostal space, a loud S2, bounding peripheral pulses, and a widened pulse
pressure. Which of the following is the most likely diagnosis?
A) Atrial septal defect (ostium primum type)
B) Atrial septal defect (ostium secundum type)
C) Atrioventricular canal
, D) Coarctation of the aorta
E) Hypoplastic left heart syndrome
F) Patent ductus arteriosus
G) Tetralogy of Fallot
H) Transposition of the great arteries
I) Tricuspid atresia
J) Ventricular septal defect✔ ✔ Patent ductus arteriosus
PDA:
More common in girls (2:1), babies where maternal rubella infection was present, and premature
infants. Typically asymptomatic; patients with large defects may present with FTT failure to thrive,
recurrent lower respiratory tract infections, lower extremity clubbing, and CHF. Wide pulse pressure,
bounding arterial pulses, and characteristic sound of "machinery" (to-and-fro murmur)
Indomethacin-induced closure helpful in premature infants. Term infants often require surgical closure.
8. One day after an uncomplicated spontaneous vaginal delivery, a 23-year-old woman, gravida 1, para
1, has the onset of loss of small amounts of urine. She received epidural anesthesia during labor and
delivery. Examination shows an episiotomy without evidence of hematoma. She is voiding 50 to 75 mL
of urine at a time. Postvoid residual volume is 300 mL.
A ) Detrusor instability
B ) Interstitial cystitis
C ) Overflow incontinence
D ) Stress incontinence
E ) Urethra diverticulum
F ) Urinary fistula
