NBME STEP 3 HIGH-YIELD PEARLS- FORM 4 REVIEW
Q&A STUDY GUIDE WITH COMPLETE SOLUTION!!
1. What ultrasound measurement confirms polyhydramnios?
Answer:
Polyhydramnios is diagnosed when the deepest vertical pocket (DVP) exceeds 8
cm on ultrasound.
Elaboration:
A DVP > 8 cm or an amniotic fluid index (AFI) > 24–25 cm indicates excess
amniotic fluid. Common causes include fetal swallowing disorders (eg, esophageal
atresia), maternal diabetes, and fetal anomalies.
2. What fetal conditions are associated with polyhydramnios?
Answer:
Esophageal atresia (impaired swallowing)
Craniofacial anomalies (such as agnathia and microstomia)
Maternal diabetes
Placental insufficiency
Genetic syndromes such as DiGeorge syndrome
,3. Why is olanzapine a concern in elderly patients with dementia?
Answer: Antipsychotics, including olanzapine, increase mortality risk in elderly
patients with dementia-related psychosis.
Elaboration: Controlled trials show higher rates of sudden cardiac death, heart
failure, and infections. Thus, antipsychotics should be avoided unless absolutely
necessary.
4. A patient with well-controlled diabetes starts olanzapine and rapidly gains
weight. What test should be ordered?
Answer:
Order a fasting serum glucose level (or HbA1c).
Elaboration:
Olanzapine can cause significant metabolic disturbance, including hyperglycemia,
new-onset diabetes, and rapid weight gain. Routine glucose monitoring is essential
even when baseline levels are normal.
5. What are the hallmark signs of Addison’s disease?
Answer: Hyperpigmentation of skin and mucosa (especially sun-exposed areas)
Fatigue, weight loss, and decreased appetite
Salt craving
Possible amenorrhea in females
Myalgias
Electrolyte abnormalities such as hyponatremia and hyperkalemia
,6. A patient feels dizzy when sitting or standing but not when running; vitals show
low-normal BP and borderline sodium and potassium. What is the likely
diagnosis?
Answer: Addison’s disease (chronic adrenal insufficiency).
Elaboration:
Exercise naturally increases cortisol production, temporarily improving symptoms.
7. What are the classic signs of acute adrenal crisis (acute Addison’s disease)?
Answer: Profound nausea and vomiting
Severe hypotension or vascular collapse
Abdominal pain resembling an acute abdomen
Very high fever (>105°F)
8. What is “intention-to-treat” analysis?
Answer:
A method in which all randomized participants are analyzed in the groups to which
they were originally assigned, regardless of adherence.
Elaboration:
, This preserves randomization and prevents bias—summarized as “once
randomized, always analyzed.”
9. What is a postoperative seroma?
Answer:
A collection of clear fluid beneath an incision.
Elaboration:
It often forms in areas with large tissue dissection or dead space. It is not infected
and differs from hematoma or abscess.
10. What are the ECG findings of atrial fibrillation?
Answer:
Irregularly irregular rhythm
No P waves
Variable ventricular response
Narrow QRS (unless preexisting bundle branch block)
Q&A STUDY GUIDE WITH COMPLETE SOLUTION!!
1. What ultrasound measurement confirms polyhydramnios?
Answer:
Polyhydramnios is diagnosed when the deepest vertical pocket (DVP) exceeds 8
cm on ultrasound.
Elaboration:
A DVP > 8 cm or an amniotic fluid index (AFI) > 24–25 cm indicates excess
amniotic fluid. Common causes include fetal swallowing disorders (eg, esophageal
atresia), maternal diabetes, and fetal anomalies.
2. What fetal conditions are associated with polyhydramnios?
Answer:
Esophageal atresia (impaired swallowing)
Craniofacial anomalies (such as agnathia and microstomia)
Maternal diabetes
Placental insufficiency
Genetic syndromes such as DiGeorge syndrome
,3. Why is olanzapine a concern in elderly patients with dementia?
Answer: Antipsychotics, including olanzapine, increase mortality risk in elderly
patients with dementia-related psychosis.
Elaboration: Controlled trials show higher rates of sudden cardiac death, heart
failure, and infections. Thus, antipsychotics should be avoided unless absolutely
necessary.
4. A patient with well-controlled diabetes starts olanzapine and rapidly gains
weight. What test should be ordered?
Answer:
Order a fasting serum glucose level (or HbA1c).
Elaboration:
Olanzapine can cause significant metabolic disturbance, including hyperglycemia,
new-onset diabetes, and rapid weight gain. Routine glucose monitoring is essential
even when baseline levels are normal.
5. What are the hallmark signs of Addison’s disease?
Answer: Hyperpigmentation of skin and mucosa (especially sun-exposed areas)
Fatigue, weight loss, and decreased appetite
Salt craving
Possible amenorrhea in females
Myalgias
Electrolyte abnormalities such as hyponatremia and hyperkalemia
,6. A patient feels dizzy when sitting or standing but not when running; vitals show
low-normal BP and borderline sodium and potassium. What is the likely
diagnosis?
Answer: Addison’s disease (chronic adrenal insufficiency).
Elaboration:
Exercise naturally increases cortisol production, temporarily improving symptoms.
7. What are the classic signs of acute adrenal crisis (acute Addison’s disease)?
Answer: Profound nausea and vomiting
Severe hypotension or vascular collapse
Abdominal pain resembling an acute abdomen
Very high fever (>105°F)
8. What is “intention-to-treat” analysis?
Answer:
A method in which all randomized participants are analyzed in the groups to which
they were originally assigned, regardless of adherence.
Elaboration:
, This preserves randomization and prevents bias—summarized as “once
randomized, always analyzed.”
9. What is a postoperative seroma?
Answer:
A collection of clear fluid beneath an incision.
Elaboration:
It often forms in areas with large tissue dissection or dead space. It is not infected
and differs from hematoma or abscess.
10. What are the ECG findings of atrial fibrillation?
Answer:
Irregularly irregular rhythm
No P waves
Variable ventricular response
Narrow QRS (unless preexisting bundle branch block)
