NBME 7 block 1 answeres

1) A angina = exercise stress test2) B fat emboli syndrome3) A repeat BP in 4 weeks4) A diabetes insipidus5) B central vein occlusion6) G small bowel obstruction7) D bilateral varicocele >> high temperature >> impaired spermatogenesis8) B decreased calcium caused by low Mg due to malnutrition9) E pilosebaceous follicles , acne10) D normal heart sound, upper respiratory tract infection11) C haloperidol for acute delirium12) E meningitis with focal neurological sign, CT scan first if focal signs present, then LP13) C child abuse , retinal Haemarrhage14) E Myaesthenia gravis >> thymoma15) A honey crusted > impetigo> topical mupirocin 16) E pregnancy causes urinary stasis17) F nystagmus >> PCP 18) B zenker diverticulum >> barium swallow19) A myasethenia gravis >> autoantibodies against postsynaptic ACH receptors20) D Gullain Barre syndrome >> axonal demyelination21) E surgical exploration22) L widened mediastinum + C5 fracture >> thoracic aorta23) A reassurance24) C family therapy , 25) D sarcoidosis >> increased calcium26) E randomized controlled trial is the only interventional study listed, the rest are observational

studies27) D pancytopenia + lymadenopathy + hepatomegaly >> suspect ALL >> BM aspiration28) G strangulated inguinal hernia >> need urgent surgery29) A renal stone colic >> increased fluid intake30) E alternating QRS + cardiomegaly >> cardiac temponade31) E gout acute attack>> indomethacin32) D no active lesions now >> can deliver vaginally33) B statin induced myopathy >> painful>> muscle lysis due to blockage of Coenzyme Q synthesis34) E terminal CA patient >> give adequate analgesic that is needed35) C mania episode >> bipolar36) C premature menopause >> low estrogen >> osteoporosis37) E hereditary spherocytosis38) E contrast induced nephropathy >> give IV fluid to prevent39) C hyperglycemia >> polyuria >> low intravascular volume >> orthostatic hypotension

40) D salad >> myonoise >> staph aureus poisioning due to preformed toxin >>due to inadequate refrigeration

41) A bamboo spine >> ankylosing spondyloytis42) B compression fracture due to prednisolone use of asthama43) E acute pancreatitis can b caused by hypertriglyceridemia44) G T lymphocyte dysfunction >> fungal and mycobacteria infection45) D positive PPD + negative CXR and sputum >> start latent TB treatment now

If negative PPD >> then repeat PPD again46) No question

BLOCK 2 NBME 7 answers

1) B flat affect >> major depression2) E dental work >> strept viridans3) A lyme >> amoxil4) B nursemaid elbow >> treatment is gentle supination and flexion5) B determine if patient wants to discuss with anyone else6) H wound dehiscene (serosangunioius discharge + wound tenderness + distension)7) C heat stroke > body temperature 1068) D fever plus neurologiv plus schistocytes9) D OCPills decrease risk of ovarian cancer and endometrial cancer10) C osteoarthirits >> 20 degree flexion hip contracture11) C post cholecystectomy >> common bile duct stricture>> need ERCP12) B organophosphate poisoining >> antidote atropine13) B tacile hallucinations with cocaine and amphetamines14) C 27 weeks gestation >> need IM betamethasone for surfantant maturation15) D uterine atony cos of big baby. (9Lb) 16) A B12 deficiency >> atrophic gastritis due to lack of intrinsic factor, schilling test proves it17) A pneumococcal, H influenza, meningococcal >> all capsulated organisms >> due to impaired B

lymphocyte thus low Ig thus impaired opsonizatoin18) F repeated staph aureus (catalase positive organism >> chronic granulomatous disease due to

NADPH oxidase deficiency in neutrophils) 19) D high calcium, low phosphate >> hyperparathyroid >> increased urinary calcim excretion20) B H influenza >> COPD + lobar pneumonia + gram neg bacilli21) B multiple painful sores >> genital herpes22) E cricothyroidectom >> facial fracture + unstable cervical spine23) C HOCM murmur gets louder on standing 24) B amyotrophic lateral sclerosis > fibrillation potentials in multiple muscles of extremities25) A education about puberty to parents and child26) B low PO2, high PCO2 >> alveolar hypoventilation27) C young patient, no warning signs >> trial of PPI first

28) E Rh incompatibility29) C acute urticaira + angioedema30) D pneumococcal31) C 6 hours is just about the time GA effect wears off>> child starts to feel pain32) F vagovagal syncope >> HR during syncope is 45/min. if hypoglycemia, should b tachycardia33) D NO cleaving of C terminal peptides on angiotensin 1, (mechanism of action of ACE) 34) C renal ultrasound, could b obstructive uropathy due to tumor >> will show hydronephrosis35) D antidote for heroin >> Naloxone36) A botulism >> pupil dilation (MS GBS doesn’t affect pupils) 37) E urethral diverticulum >> midline mass in vaginal wall38) B low cardiac index >> cardiogenic shock >> high PCWP >> acute pulmonary edema>> give

diuretics39) A ETEC 40) A PCOS >> give clomiphene 41) E if HBS antibodies are already present >> no treatment or vaccine or Ig is necessary42) C diuretics causes low K >> digoxin toxicity >> premature ventricular beats43) E metastasis to bone >> hyper Ca >> confusion44) E stenosis above 70% >> carotid enarterectomy45) A wide based gait >> cerebellar degeneration due to alcohol >> abstinence from alcohol46) D congestive cardiac failure ( perihilar haziness with upper lobe veins dilation)

BLOCK 3 answers

1) D digestive enzyme deficiency >> lactose intolerance2) C epidural haematoma compressing the spinal cord3) A brisk rotatory nystagmus needs futhur evaluation4) B hypothyroid5) C thiamine deficiency6) B C1 esterase inhibitor deficiency >> hereditary angioedema7) D measurement of serum amylase activity, acute pancreatitis8) C pre eclampsia >> check platelet count to rule out HELLP syndrome9) B atherosclerosis of femoropopliteal arteries10) D achalasia >> decreased peristalsis, increase LES tone11) F lorazepam therapy >> MRI claustrophobia) 12) A CXR >> due to decreased breath sound at left lung base, high WBC count, low grade fever 13) D psychogenic polydipsia >> low serum Na, low urine osmolarity14) B central umblication >> molluscum contigiosum > check HIV 15) F tenderness at tibial tubercle >> Osgood schlatter>> repeated microfracture at tendon

insertion

16) A DVT >> duplex scan17) A subconjuctiva hamarrhage >> reassurance18) A bartholin duct cyst19) A tenderness on palpation >> costchondritis20) A low cardiac index , high PCWP >> cardiogenic shock21) A lead poisoning > calcium disodium edetate22) No question23) No question24) B cor pulomale due to right heart failure due to pulmonary embolism25) E SLE 26) H paget’s disease of breast27) B ductal ectasia28) B mixed metabolic acidosis and respiratory alkalosis >> use winter’s formula29) E CS section, station too high for forceps and giving oxytocin will futher deteriorate fetal late

deceleration30) A allergic bronchopulmonary aspergillosis31) B brief psychotic disorder >> auditory hallucination of brother’s voice32) D GBS prophylaxis >> IV pen G 33) A pituitary microadenoma >> prolactinoma >> medical therapy34) C fever + pharyngitis + splenomegaly >> EBV35) A acute stress disorder36) F multiple myeloma > abnormal IG > abnormal opsonization > increased risk for capsulated

organism infection > strept pneumonia 37) C piles >> need to exclude Ca colon compressing the venous drainage> colonoscopy38) E aortic dissection39) D acute tubular necrosis40) D increase sensitivity, decrease specificity41) B high eosinophils > parasite > cutaneous larva migrans42) A acute cholecystitis43) A need to look for synchromnous or metachronous tumor>> colonoscopy44) B xray of left hip45) A aspiration >> pneumonia46) No question

BLOCK 4

1. E TPN + Hais loss >> zinc deficiency2. C destruction and dilation of distal airways >> emphysema3. C colposcopy

4. Statsis dermatitis with ulcer, ( no question) 5. G schizophrenia6. C hypovolemia due to severe nausea and vomiting of acute pancreatitis7. D acute lymphcytic leukemia >> increased LDH 8. No question. Answer B 9. B dopamine10. No question answer oral PTU ( graves)11. E fluid rescuitiation failure >> give blood transfusion12. F amurosis fugax + stroke > internal carotid artery13. A abruption placenta14. E spondylolisthesis15. E spinal dysraphism >> club foot and loss of motar sensory16. F wiskoff Aldrich syndrome17. C IV 0.9% Normal saline18. A acute myocardial infarct >> ST elevation in V2 V3 V419. I ventricular tachycardia >> wide QRS complex20. E staphyloccous aureus >> vancomycin21. C magnesium sulfate >> tocolysis22. E organophosphate poisioning23. H pulmonary embolism >> pulmonary infarct > pleuritic chest pain 24. A observation25. B torticollis >> fibrosis of sternomastoid muscle26. A bronchogenic carcinoma27. I schizophrenia >> olanzapine therapy28. E PID29. C cryoglobulinemia > treat the cause > hep C > treatment is IL alpha30. D give all recommended immunizations for age31. E no intervention is necessary32. No question33. C diabetic nephropathy >> add Lisinopril34. F pill induced oesophagitis35. D SIADH low serum Na, high urine osmolarity36. A mitral valve incompetence, rheumatic fever37. F surreptitious administration of thyroxine38. G viral infection39. D pleural metastases40. E radiation therapy. vertebral metastasis compressing spinal cord41. B optic neuritis42. E no therapy indicated at this time43. B appendicitis44. C finasteride, ( patient has orthostatic hypotension so doxazosin cant b used) 45. A coercion of a vulnerable population

46. A observation