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NBME 7 block 1 answeres

1) A angina = exercise stress test


2) B fat emboli syndrome
3) A repeat BP in 4 weeks
4) A diabetes insipidus
5) B central vein occlusion
6) G small bowel obstruction
7) D bilateral varicocele >> high temperature >> impaired spermatogenesis
8) B decreased calcium caused by low Mg due to malnutrition
9) E pilosebaceous follicles , acne
10) D normal heart sound, upper respiratory tract infection
11) C haloperidol for acute delirium
12) E meningitis with focal neurological sign, CT scan first if focal signs present, then LP
13) C child abuse , retinal Haemarrhage
14) E Myaesthenia gravis >> thymoma
15) A honey crusted > impetigo> topical mupirocin
16) E pregnancy causes urinary stasis
17) F nystagmus >> PCP
18) B zenker diverticulum >> barium swallow
19) A myasethenia gravis >> autoantibodies against postsynaptic ACH receptors
20) D Gullain Barre syndrome >> axonal demyelination
21) E surgical exploration
22) L widened mediastinum + C5 fracture >> thoracic aorta
23) A reassurance
24) C family therapy ,
25) D sarcoidosis >> increased calcium
26) E randomized controlled trial is the only interventional study listed, the rest are observational
studies
27) D pancytopenia + lymadenopathy + hepatomegaly >> suspect ALL >> BM aspiration
28) G strangulated inguinal hernia >> need urgent surgery
29) A renal stone colic >> increased fluid intake
30) E alternating QRS + cardiomegaly >> cardiac temponade
31) E gout acute attack>> indomethacin
32) D no active lesions now >> can deliver vaginally
33) B statin induced myopathy >> painful>> muscle lysis due to blockage of Coenzyme Q synthesis
34) E terminal CA patient >> give adequate analgesic that is needed
35) C mania episode >> bipolar
36) C premature menopause >> low estrogen >> osteoporosis
37) E hereditary spherocytosis
38) E contrast induced nephropathy >> give IV fluid to prevent
39) 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 spondyloytis
42) B compression fracture due to prednisolone use of asthama
43) E acute pancreatitis can b caused by hypertriglyceridemia
44) G T lymphocyte dysfunction >> fungal and mycobacteria infection
45) D positive PPD + negative CXR and sputum >> start latent TB treatment now
If negative PPD >> then repeat PPD again
46) No question

BLOCK 2 NBME 7 answers
1) B flat affect >> major depression
2) E dental work >> strept viridans
3) A lyme >> amoxil
4) B nursemaid elbow >> treatment is gentle supination and flexion
5) B determine if patient wants to discuss with anyone else
6) H wound dehiscene (serosangunioius discharge + wound tenderness + distension)
7) C heat stroke > body temperature 106
8) D fever plus neurologiv plus schistocytes
9) D OCPills decrease risk of ovarian cancer and endometrial cancer
10) C osteoarthirits >> 20 degree flexion hip contracture
11) C post cholecystectomy >> common bile duct stricture>> need ERCP
12) B organophosphate poisoining >> antidote atropine
13) B tacile hallucinations with cocaine and amphetamines
14) C 27 weeks gestation >> need IM betamethasone for surfantant maturation
15) D uterine atony cos of big baby. (9Lb)
16) A B12 deficiency >> atrophic gastritis due to lack of intrinsic factor, schilling test proves it
17) A pneumococcal, H influenza, meningococcal >> all capsulated organisms >> due to impaired B
lymphocyte thus low Ig thus impaired opsonizatoin
18) 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 excretion
20) B H influenza >> COPD + lobar pneumonia + gram neg bacilli
21) B multiple painful sores >> genital herpes
22) E cricothyroidectom >> facial fracture + unstable cervical spine
23) C HOCM murmur gets louder on standing
24) B amyotrophic lateral sclerosis > fibrillation potentials in multiple muscles of extremities
25) A education about puberty to parents and child
26) B low PO2, high PCO2 >> alveolar hypoventilation
27) C young patient, no warning signs >> trial of PPI first
28) E Rh incompatibility
29) C acute urticaira + angioedema
30) D pneumococcal
31) C 6 hours is just about the time GA effect wears off>> child starts to feel pain
32) F vagovagal syncope >> HR during syncope is 45/min. if hypoglycemia, should b tachycardia
33) 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 hydronephrosis
35) D antidote for heroin >> Naloxone
36) A botulism >> pupil dilation (MS GBS doesnt affect pupils)
37) E urethral diverticulum >> midline mass in vaginal wall
38) B low cardiac index >> cardiogenic shock >> high PCWP >> acute pulmonary edema>> give
diuretics
39) A ETEC
40) A PCOS >> give clomiphene
41) E if HBS antibodies are already present >> no treatment or vaccine or Ig is necessary
42) C diuretics causes low K >> digoxin toxicity >> premature ventricular beats
43) E metastasis to bone >> hyper Ca >> confusion
44) E stenosis above 70% >> carotid enarterectomy
45) A wide based gait >> cerebellar degeneration due to alcohol >> abstinence from alcohol
46) D congestive cardiac failure ( perihilar haziness with upper lobe veins dilation)


BLOCK 3 answers
1) D digestive enzyme deficiency >> lactose intolerance
2) C epidural haematoma compressing the spinal cord
3) A brisk rotatory nystagmus needs futhur evaluation
4) B hypothyroid
5) C thiamine deficiency
6) B C1 esterase inhibitor deficiency >> hereditary angioedema
7) D measurement of serum amylase activity, acute pancreatitis
8) C pre eclampsia >> check platelet count to rule out HELLP syndrome
9) B atherosclerosis of femoropopliteal arteries
10) D achalasia >> decreased peristalsis, increase LES tone
11) 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 osmolarity
14) B central umblication >> molluscum contigiosum > check HIV
15) F tenderness at tibial tubercle >> Osgood schlatter>> repeated microfracture at tendon
insertion
16) A DVT >> duplex scan
17) A subconjuctiva hamarrhage >> reassurance
18) A bartholin duct cyst
19) A tenderness on palpation >> costchondritis
20) A low cardiac index , high PCWP >> cardiogenic shock
21) A lead poisoning > calcium disodium edetate
22) No question
23) No question
24) B cor pulomale due to right heart failure due to pulmonary embolism
25) E SLE
26) H pagets disease of breast
27) B ductal ectasia
28) B mixed metabolic acidosis and respiratory alkalosis >> use winters formula
29) E CS section, station too high for forceps and giving oxytocin will futher deteriorate fetal late
deceleration
30) A allergic bronchopulmonary aspergillosis
31) B brief psychotic disorder >> auditory hallucination of brothers voice
32) D GBS prophylaxis >> IV pen G
33) A pituitary microadenoma >> prolactinoma >> medical therapy
34) C fever + pharyngitis + splenomegaly >> EBV
35) A acute stress disorder
36) 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> colonoscopy
38) E aortic dissection
39) D acute tubular necrosis
40) D increase sensitivity, decrease specificity
41) B high eosinophils > parasite > cutaneous larva migrans
42) A acute cholecystitis
43) A need to look for synchromnous or metachronous tumor>> colonoscopy
44) B xray of left hip
45) A aspiration >> pneumonia
46) No question


BLOCK 4
1. E TPN + Hais loss >> zinc deficiency
2. C destruction and dilation of distal airways >> emphysema
3. C colposcopy
4. Statsis dermatitis with ulcer, ( no question)
5. G schizophrenia
6. C hypovolemia due to severe nausea and vomiting of acute pancreatitis
7. D acute lymphcytic leukemia >> increased LDH
8. No question. Answer B
9. B dopamine
10. No question answer oral PTU ( graves)
11. E fluid rescuitiation failure >> give blood transfusion
12. F amurosis fugax + stroke > internal carotid artery
13. A abruption placenta
14. E spondylolisthesis
15. E spinal dysraphism >> club foot and loss of motar sensory
16. F wiskoff Aldrich syndrome
17. C IV 0.9% Normal saline
18. A acute myocardial infarct >> ST elevation in V2 V3 V4
19. I ventricular tachycardia >> wide QRS complex
20. E staphyloccous aureus >> vancomycin
21. C magnesium sulfate >> tocolysis
22. E organophosphate poisioning
23. H pulmonary embolism >> pulmonary infarct > pleuritic chest pain
24. A observation
25. B torticollis >> fibrosis of sternomastoid muscle
26. A bronchogenic carcinoma
27. I schizophrenia >> olanzapine therapy
28. E PID
29. C cryoglobulinemia > treat the cause > hep C > treatment is IL alpha
30. D give all recommended immunizations for age
31. E no intervention is necessary
32. No question
33. C diabetic nephropathy >> add Lisinopril
34. F pill induced oesophagitis
35. D SIADH low serum Na, high urine osmolarity
36. A mitral valve incompetence, rheumatic fever
37. F surreptitious administration of thyroxine
38. G viral infection
39. D pleural metastases
40. E radiation therapy. vertebral metastasis compressing spinal cord
41. B optic neuritis
42. E no therapy indicated at this time
43. B appendicitis
44. C finasteride, ( patient has orthostatic hypotension so doxazosin cant b used)
45. A coercion of a vulnerable population
46. A observation