NBME Form 6

Block 1:
2 D The USPSTF recommends screening for chlamydia and chlamydia in sexually active women age 24
years and younger and in older women who are at increased risk for infection.

A simply observer for mary jane effect...marijuana has a very good prognosis..clears out of the
body in couple of days.

7I
10
C) Postoperative intra-abdominal hemorrhage...tender abdomen and distention plus absent bowel
sounds,?

11 F " to and fro" murmur means continuous like "continuous machinery murmur" PDA
PDA also has wide pulse pressure.
coarctation of the aorta does have bounding pulses and higher arm pressure than leg
pressure, but you actually have to give prostaglandin to keep PDA open in coarc...so
legs get higher perfusion of blood.

Frequent respiratory infections (eg, colds, pneumonia) due to

decreased blood oxygenation leading to decreased functioning of the
immune system to resist infection and of the respiratory system to
expel offending microorganisms

16 C
Gallstone Ileus is an infrequent cause of mechanical bowel obstruction. It is caused by an impaction
of a gallstone in the terminal ileum by passing through a billiary-enteric fistula (often from
duodenum). It occurs more frequently in women with average age of 70 years.
Clinical picture: Episodic subacute obstruction in an elderly female. Abdominal pain and vomiting
which subside as the gallstone becomes disimpacted, and only recurs again as the progressively
larger stone lodges in the more distal bowel lumen. Intermittent symptoms may be present for
some days prior to evaluation. Hematemesis could occur as an occasional complication that is due
to hemorrhage at the site of the biliary enteric fistula.
Physical examination: The patient may be febrile and often appears dehydrated. Common
abdominal signs include distension and increased bowel sounds. Jaundice is uncommon, occurring in
less than 15% of cases. Many affected patients have serious concomitant medical illnesses,
including coronary disease, diabetes mellitus or pulmonary disease.
Diagnosis: The most important diagnostic test is abdominal plain film. The diagnosis of gallstone
ileus is made preoperatively in about one-half of cases. The radiographig findings of gallstone ileus,
are:
Signs of partial or complete intestinal obstruction
Air in the biliary tree (pneumobilia)
Direct visualization of the stone

Change in position of a previously located stone

Two adjacent small bowel air-fluid levels in the right upper quadrant

22 C seen in dehydratio
26 D It is D insulin resistance usually in type 2 insulin levels are high
27 C this is SBP
29 G agree w/ TB, Weight Loss, Nigh Sweats, Chills, Fever, Hilar adenopathy w/
Pleural Efusion

31 L
33

it is asthma exacerbation by viral infections ..the clues :

nightly cough
expiratory weezing
decrease in expiratory flow

35 A androgens are for libido

39
Pt. had viral myocarditis now giving him dilated cardiomyopathy, presenting as diffuse hypokinesia

46 B
Block 2:
1H
2 C r logic is correct but ans is C....gag is decreased in
debilitated,alcoholic,unconscious,demented elderly etc....+ look at the location of the
nfiltrate...it matches with aspiration associated site...plu the previous viral inf
predisposed him to decreased ciliary clearance..
so its C..most appropriate.

14 The rising life expectancy of cancer patients has led to a greater need for treatment of
spinal metastases. For spinal canal compression or impending spinal instability, the
treatment of choice is decompression and stabilization, by either a dorsal approach
(lumbar and thoracic spine) or a ventral approach (cervical spine).
26
Block 3:
5 Ulnar Nerve Entrapment at the elbow (UNE)
============================
Symptoms:
Numbness or paresthesias in ulnar aspect of hand
Precipitating activities:
Elbow flexion during sleep;
Elbow resting on desk

 Examination:
Sensory loss in the little finger and ulnar half of ring finger.
Weakness of the interossei and thumb adductor; claw-hand
Electro-Diagnosis:
Focal slowing of nerve conduction velocity at the elbow
Differential Dx:
Thoracic outlet Sd
C8-T1 radiculopathy
Treatment:
Elbow pads
Avoid further injury
Surgery when conservative treatment fails.

10 A
15 Its PE so heparin. In fat embolism there is petechial rash in the axilla and neck ans also
bilateral patchy infiltrates on CXR.

17 B transudate has low protein

24
Block 4:
4
8
30
33 or 35
36
39