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
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 doesn’t 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 paget’s disease of breast 27) B ductal ectasia
28) B mixed metabolic acidosis and respiratory alkalosis >> use winter’s 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 brother’s 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
