NBME 9 QUESTIONS WITH COMPLETE VERIFIED SOLUTIONS 2024/2025, Exams of Health sciences

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NBME 9 QUESTIONS WITH COMPLETE VERIFIED SOLUTIONS 2024/2025 Kid with bed wetting problems + constipation tx? administration of an osmotic laxative Multiple myeloma is marked by proliferation of ______ B cells monoclonal In patients with bipolar disorder that are suffering from acute depression + stopped taking meds, what do you give them? bipolar medication like lithium, lamotrigine, quetiapine, and lurasidone SSRIs in bipolar patients can be bad because? it can precipitate mania or convert depression to mania Patient with afib with a history of TIA or stroke Tx? warfarin Patient without afib with history of TIA or stroke Tx? aspirin T/F: Aspirin and clopidogrel are anticoagulants false 1st line therapy for mild to moderate acne vulgaris Tx? topical retinoids Patient with juvenile idiopathic arthritis may present with what extraarticular manifestation? uveitis (screen with slit-lamp exam) In adults, the presence of a destructive bone lesion is more commonly caused by ______ disease rather than primary bone malignancy metastatic T/F: Osteosarcoma is most common in patients ____ years of age <30 Patients with severe AS with symptoms or systolic dysfunction (EF <50%) should receive what tx? aortic valve replacement Patients with HF (EF < 50%) who have AS + asymptomatic in terms of SOB on exertion, should receive what treatment? Afterload reduction 32 yo woman with bcg vaccine as a child + emigrated from China + PPD skin test of 12 mm risk status and next step? High risk; isoniazid 92 yr old with left mandibular mass that has enlarged + x ray is normal + smoker + normal VS next step? biopsy 77 yr old woman with 1 day hx of nausea + vomiting + confusion + has HTN + on diltiazem + BP 160/70 + ox 84% + JVD borderline high + crackles in lungs + S3 + edema + signs of kidney injury Dx and next step? fluid overload; hemodialysis In diabetic patients, foot injuries can be prevented with? wearing shoes when standing or walking In diabetic patients, worsening of foot injuries can be prevented with? daily foot checks 37 yr old woman with no hx of abnormal pap smears + current visit shows pap smear with atypical glandular cells potential dx and next step? endometrial malignancy; colposcopy with endocervical curettage 37 yr old woman with no hx of abnormal pap smears + current visit shows pap smear with atypical glandular cells After colposcopy with endocervical curettage, what can be considered as a next step? hysteroscopy T/F: Neonate that improved with PPV can be taken off of PPV immediately after true If there is suspected FSGS, what is the next step? 1st line tx for pulseless sustained (>30 seconds) VT? defibrillation ECG with narrow QRS + no p wave in between QRS complexes, just T wave dx? premature atrial contraction T/F: LDL cholesterol is essential for assessing cardiovascular risk false T/F: HDL and total cholesterol can be enough to assess cardiovascular risk. true In patients without risk factors who are aged 40-45 can be screened for cholesterol every ____ 3-5 years 47 yr old post collision + unrestrained + conscious on arrival and followed commands + pulse 110 + BP 90/55 + resuscitated en route with IL of LR + SOB and chest pain + nasogastric tube inserted ---> BP 130/70 + x-ray shows fluid at base of left lung field, fluid density at left pleural apex + NG tube deviated to right in upper mediastinal region --> BP 80/40 dx? aortic transection T/F: Eye exam in NF2 patients can be done annually. false T/F:MRI of brain is needed for NF2 patients annually true 62 yr old woman with 6 month hx of increasingly severe left knee pain + no history of trauma + giving away sensation while walking + worse when walking up stairs or sitting in car + tenderness to palpation along patella + sensation decreased over left hallux + BMI 46 dx? chondromalacia patella 22 yr old woman with 6 month hx of increasingly severe left knee pain + history of injury during basketball game a year ago + giving away sensation while walking + worse when walking up stairs or sitting in car + tenderness to palpation along patella + sensation decreased over left hallux + BMI 46 dx? ACL tear 22 yr old woman with 1 week hx of increasingly severe left knee pain + history of injury during basketball game 8 days ago + knee effusion + tenderness over medial joint line dx? medial meniscus tear 22 yr old woman with 1 week hx of increasingly severe left knee pain + works as a cleaning lady + acute pain + erythema + swelling over anterior knee + pain on knee flexion dx? prepatellar bursitis 44 yr old woman with 2 week hx of non productive cough that worsens at night (paroxysmal) + no fever, night sweats, weight loss or bloody sputum (less likely malignancy) + began as sore throat, runny nose that improved (catarrhal) --> coughing then began likely dx and next step? pertussis; bordetella pertussis PCR Patient with exercise induced asthma. Fist step? inhaled albuterol therapy 1St line tx for UC? meSalamine 2nd line tx for UC? azathioprine and infliximab 47 yr old man at routine visit + maternal grandma had colon cancer at 47 years old (not first degree relative) + smoker + drinks occasionally + BMI 27 risk status and recommendation? average risk; colonoscopy at age of 50 years 47 yr old man at routine visit + mother had colon cancer at 47 years old (first degree relative) + smoker + drinks occasionally + BMI 27 risk status and recommendation? moderate/high; colonoscopy now 72 yr old woman with 3 day hx of bright red rectal bleeding + 7 yrs ago had mild diverticular disease + EF of 15% + appears healthy + S3 + TTP on LLQ with minimal guarding + small amount of blood + afebrile + BP 90/65 dx? ischemic colitis 72 yr old woman with 3 day hx of bright red rectal bleeding + 7 yrs ago had mild diverticular disease + EF of 45% + appears healthy + S3 + TTP on LLQ with minimal guarding + small amount of blood + temp 103 + BP 90/65 dx? diverticulitis 52 yr old woman with 5 day hx of constant abdominal pain, nausea, and decreased appetitie + had cholecystectomy 9 days ago + discharged 7 days ago + temp 100.8 high urea + high bilirubin + high AST + US of abdomen is normal likely dx and next step? bile duct leak s/t cholecystectomy; ERCP T/F: VWD usually presents with irregular menses. false 24 yr old college student with 20 day hx of intermittent heavy vaginal bleeding with passage of clots + fatigue and lightheadedness with no visual changes or headaches + no hx of brusing + irregular menses most likely cause of heavy menses? anovulation 24 yr old college student with 20 day hx of constant heavy vaginal bleeding with passage of clots + fatigue and lightheadedness with no visual changes or headaches + hx of brusing + regular menstruation most likely cause of heavy menses? VWD Progesterone therapy in amenorrheic patients is given and withdrawn. If menses occurs after withdrawal, then the cause of amenorrhea is most likely _______ impaired hypothalamic-pituitary-ovarian axis Progesterone therapy in amenorrheic patients is given and withdrawn. If menses does NOT occur after withdrawal, then the cause of amenorrhea is most likely _______ structural abnormality, uterus abnormality, or estrogen deficiency T/F: Estrogen deficiency in the setting of amenorrheic patient is likely to present with no menses after withdrawal of progesterone therapy true T/F: HPA axis impairment in the setting of amenorrheic patient is likely to present with no menses after withdrawal of progesterone therapy false T/F: Fat embolism is common in scuba divers experiencing AMS, chest pain, dyspnea and wheezing. false Diver with sinus pain, congestion, and nasal discharge dx and pathophys? sinus barotrauma; sinus obstruction in sinus pressure and environmental pressure T/F: Unstable or worsening angina requires inpatient observation true 4 yr old boy with 3 day hx of fever, cough, runny nose + no chest congestion, sputum, chest discomfort or SOB Likely dx? upper respiratory tract infection T/F: It is likely to see idiopathic pulmonary hypertension in children false T/F: Idiopathic pulmonary hypertension presents with shortness of breath, chest discomfort on exertion, RHF, loud P2 and/or tricuspid regurg. true Mandibular mass on 77 yr old man requires what first step? fine needle aspiration biopsy of mass 27 yr old with 5 day hx of headache, severe diffuse abdominal pain and N/V + exacerbated by eating and relived by vomiting + hx of Crohn disease + did not taper dosage 2 weeks ago + distended abdomen + BP low + bowel sonds decreased + vomitous semi solid -->liquid (after bowels emptied) + LMP 7 weeks ago dx? SBO d/t Crohn flare up 27 yr old with 5 day hx of headache, severe LUQ abdominal pain and N/V + exacerbated by eating and relived by vomiting + hx of Crohn disease + did not taper dosage 2 weeks ago + distended abdomen + BP low + bowel sonds decreased + vomitous semi solid -->liquid (after bowels emptied) + LMP 7 weeks ago + succussion splash dx? gastric outlet obstruction 65 yr old woman with 6 month hx of Upper abdominal pain that radiates back, foul smelling diarrhea + worse after eating + normals amlyase/lipase + HTN + occasional N/V + MRCP shows calcifications and pancreatic duct obstruction (no masses) dx and next step? chronic pancreatitis; pancreatic enzyme supplementation 65 yr old woman with 6 month hx of Upper abdominal pain that radiates back, foul smelling diarrhea + worse after eating + normals amlyase/lipase + HTN + occasional N/V + MRCP shows singular lesion and pancreatic duct obstruction (no masses) dx and next step? cancer; pancreatic resection T/F: Forceps/vacuum delivery needs station to be at least at 0. true T/F: You can do forceps/vacuum delivery at a patient with fetal station of -1. false _______ stage of labor (latent + active) occcurs until cervical dilaton and effacement completion. First Latent stage of labor (1st stage) occurs until the cervix is _____ cm dilated 4-6 Active stage of labor (1st stage) occurs until the cervix is _______ completely dilated In active stage, cervix must dilate at least _____ cm per hour 1-2 Arrest of labor occurs when there is no cervical change for greater than ____ hours with adequate contraction. 4 Arrest of labor occurs when there is no cervical change for greater than ____ hours with inadequate contraction. 6 T/F: Arrest of labor can be managed initially with oxytocin and prostaglandins for cervical ripening false T/F: Arrest of labor should be managed with C-section true T/F: Protraction of labor during active labor should be managed initially with C-section false T/F: Protraction of labor during active labor should be managed initially with oxytocin and prostaglandins to assist in cervical ripening. true 37 yr old Gravida 5 who has anterior placenta previa at 21 weeks + 5 c-sections previously at term She is at greatest risk for? placenta accreta 37 yr old Gravida 5 who has multilobate placenta and velamentous cord insertion at 21 weeks + 5 c-sections previously at term She is at greatest risk for? vasa previa 24 hour urinary cortisol is used for diagnosing? Cushing disease Late night salivary cortisol concentration is used for diagnosing? Cushing disease Low-dose overnight dexamethasone suppression test is used for diagnosing? Cushing disease 8AM serum cortisol is used for diagnosing? adrenal insufficiency 62 yr old with alcoholism has blurred vision for 3 weeks after tx of abdominal abscess d/t diverticulitis with perforation + had diverting colostomy, colon resection, and abscess drainage + postop course included sepsis + on regular diet + febrile + fundoscopic exam shows patchy white infiltrates b/l + nopapilledema dx? candidal ophthalmitis 62 yr old with alcoholism has blurred vision for 3 weeks after tx of abdominal abscess d/t diverticulitis with perforation + had diverting colostomy, colon resection, and abscess drainage + postop course included sepsis + on regular diet + afebrile + visual exam shows nystagmus + amnesia +ataxia dx? vitamin b1 thiamine deficiency Prevalence ratio greater than 1.0 indicates? condition is more prevalent in the population making up the numerator Prevalence ratio less than 1.0 indicates? condition is more prevalent in the population making up the denominator Light pink, ill-defined macules with gritty texture in face, ears and dorsal hands in a farmer dx? actinic keratosis Hyperkeratotic, erythematous crusted plaque with areas of ulceration in a solid organ transplant dx? squamous cell carcinoma T/F: Basal cell carcinomas have hyperkeratotic crust false Standard of care in surgeries such as total knee replacements is to give periooperative abx such as? cefazolin (1st and 2nd cephalosporin) Standard of care in GI surgeries is to give periooperative abx such as? ciprofloxacin and metronidazole (gram -, anaerobic coverage)