NBME 9 TEST WITH COMPLETE SOLUTION 2023-2024, Exams of Nursing

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_______ stage of labor (latent + active) occcurs until cervical dilaton and effacement completion. - ✔First 1st line therapy for mild to moderate acne vulgaris Tx? - ✔topical retinoids 1st line tx for Merniere's disease - ✔antihistamines (e.g. Meclizine) 1st line tx for pulseless sustained (>30 seconds) VT? - ✔defibrillation 1st line tx for STABLE sustained (>30 seconds) VT? -(lidocaine, amiodarone) ✔Class I or III anti-arrhythmics

1St line tx for UC? - ✔meSalamine 1st line tx for unstable sustained (>30 seconds) VT? - ✔synchronized cardioversion 2nd line tx for refractory Merniere's disease - ✔methylprednisolone 2nd line tx for UC? - ✔azathioprine and infliximab 4 yr old boy with 2 day hx of increasingly severe pain in right leg with limp + 1 week agowas treated with amoxicillin for middle ear infection + right hip flexed and externally rotated + passive ROM of right hip limited by pain + xray normal + no history of falls ortrauma

likely dx and next step? -markers ✔transient synovitis; measurement of serum inflammatory

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 4 yr old boy with 5 day hx of increasingly severe pain in right leg with limp + 1 year agowas treated with amoxicillin for middle ear infection + right hip flexed and externally rotated + passive ROM of right hip limited by pain + xray normal (not as sensitive) + fell7 days ago

likely dx and next step? - ✔fracture; CT scan of right hip 8AM serum cortisol is used for diagnosing? - ✔adrenal insufficiency

22 yr old woman with 1 week hx of increasingly severe left knee pain + history of injuryduring 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 acleaning lady + acute pain + erythema + swelling over anterior knee + pain on knee flexion dx? - ✔prepatellar bursitis 22 yr old woman with 6 month hx of increasingly severe left knee pain + history of injuryduring basketball game a year ago + giving away sensation while walking + worse when walking up stairs or sitting in car + tenderness to palpation along patella + sensationdecreased over left hallux + BMI 46

dx? - ✔ACL tear 24 hour urinary cortisol is used for diagnosing? - ✔Cushing disease 24 yr old college student with 20 day hx of constant heavy vaginal bleeding withpassage of clots + fatigue and lightheadedness with no visual changes or headaches + hx of brusing + regular menstruation most likely cause of heavy menses? - ✔VWD 24 yr old college student with 20 day hx of intermittent heavy vaginal bleeding withpassage 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 woman who has fever + diffuse tenderness on bimanual + tender uterus + 28hours post vaginal delivery

potential dx and next step? - ✔endometritis; IV abx 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 27 yr old woman g3p2 at 8 weeks gestation + hx of STD 1 year ago treated withpenicillin + partner recently treated for non-gonococcal urethritis + uterus consistent with 8 week gestation + speculum shows heavy mucopuruelent discharge with friable cervix dx and next step? - ✔acute cervicitis (chlamydia, gonorrhea, trich, HSV, BV); azithro 32 yo woman with bcg vaccine as a child + emigrated from China + PPD skin test of 12mm

risk status and next step? - ✔High risk; isoniazid 37 yr old Gravida 5 who has anterior placenta previa at 21 weeks + 5 c-sectionspreviously at term

She is at greatest risk for? - ✔placenta accreta 37 yr old Gravida 5 who has multilobate placenta and velamentous cord insertion at 21weeks + 5 c-sections previously at term

She is at greatest risk for? - ✔vasa previa 37 yr old woman with no hx of abnormal pap smears + current visit shows pap smearwith atypical glandular cells

After colposcopy with endocervical curettage, what can be considered as a next step? - ✔hysteroscopy 37 yr old woman with no hx of abnormal pap smears + current visit shows pap smearwith atypical glandular cells

potential dx and next step? - ✔endometrial malignancy; colposcopy with endocervical curettage 42 yr old with nontender lump on right side of neck + moves while swallowing + nolymphadenopathy

likely dx and test to establish diagnosis? - ✔thyroid nodule; FNA biopsy

42 yr old with nontender lump on right side of neck + moves while swallowing + nolymphadenopathy

likely dx and test to evaluate mass before surgical procedure? - ✔thyroid nodule; CT scan 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) --> coughingthen began

likely dx and next step? - ✔pertussis; bordetella pertussis PCR 47 yr old man at routine visit + maternal grandma had colon cancer at 47 years old (notfirst 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 degreerelative) + smoker + drinks occasionally + BMI 27

risk status and recommendation? - ✔moderate/high; colonoscopy now 47 yr old man with SOB during ambulation and at rest for 24 hours + had chemotherapyw/ doxorubicin 4 months ago + resting pulse increased during chemo period + EF is now 40% + ECG sinus tach but otherwise normal dx and pathophys? - ✔CHF; doxorubicin caused dilated cardiomyopathy 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/ dx? - ✔aortic transection 52 yr old woman with 5 day hx of constant abdominal pain, nausea, and decreasedappetitie + had cholecystectomy 9 days ago + discharged 7 days ago + temp 100.

high urea + high bilirubin + high AST + US of abdomen is normal likely dx and next step? - ✔bile duct leak s/t cholecystectomy; ERCP

52 yr old woman with T2DM presenting after 24 hours of vomiting + Na 127 + glucose 890

dx and pathopys? - ✔HHS; hyperosmolarity 62 yr old with alcoholism has blurred vision for 3 weeks after tx of abdominal abscessd/t diverticulitis with perforation + had diverting colostomy, colon resection, and abscess drainage + postop course included sepsis + on regular diet + afebrile + visual examshows nystagmus + amnesia +ataxia

dx? - ✔vitamin b1 thiamine deficiency 62 yr old with alcoholism has blurred vision for 3 weeks after tx of abdominal abscessd/t diverticulitis with perforation + had diverting colostomy, colon resection, and abscess drainage + postop course included sepsis + on regular diet + febrile + fundoscopicexam shows patchy white infiltrates b/l + nopapilledema

dx? - ✔candidal ophthalmitis 62 yr old woman with 6 month hx of increasingly severe left knee pain + no history oftrauma + 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 65 yr old woman with 6 month hx of Upper abdominal pain that radiates back, foulsmelling 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, foulsmelling 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 72 yr old woman with 3 day hx of bright red rectal bleeding + 7 yrs ago had milddiverticular disease + EF of 15% + appears healthy + S3 + TTP on LLQ with minimal guarding + small amount of blood + afebrile + BP 90/ dx? - ✔ischemic colitis

72 yr old woman with 3 day hx of bright red rectal bleeding + 7 yrs ago had milddiverticular disease + EF of 45% + appears healthy + S3 + TTP on LLQ with minimal guarding + small amount of blood + temp 103 + BP 90/ dx? - ✔diverticulitis 77 yr old woman with 1 day hx of nausea + vomiting + confusion + has HTN + ondiltiazem + BP 160/70 + ox 84% + JVD borderline high + crackles in lungs + S3 + edema + signs of kidney injury Dx and next step? - ✔fluid overload; hemodialysis 92 yr old with left mandibular mass that has enlarged + x ray is normal + smoker +normal VS

next step? - ✔biopsy Acidosis happens if pH is less than ___ - ✔7. Active stage of labor (1st stage) occurs until the cervix is _______ - ✔completely dilated 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 withinadequate contraction. - ✔ 6

Attributable risk formula -unexposed ✔difference between outcome incidence among exposed vs.

B1 is primary absorbed where? - ✔jejunum Bleeding in 48 yr old bleeding + 2.5 cm submucosal fibroid Dx and next step? - ✔fibroid; myomectomy Can be used to treat gram + bacterial infections (and to a lesser degree, gram negative like E. coli) - ✔Cefazolin COPD daily management should include? - ✔LABA, tiotropioum, steroids COPD exacerbations can be treated with? -antibiotics, and nebulizers ✔supplemental oxygen, SABA, steroids,

Diagnostic tool for DDH? - ✔US Diver with joint pain, pruritis, paralysis, hypoxemia, dyspnea, wheezing, and AMS dx and pathophys? - ✔decompression sickness; tissues release gas Diver with sinus pain, congestion, and nasal discharge dx and pathophys? - ✔sinus barotrauma; sinus obstruction in sinus pressure and environmental pressure ECG with narrow QRS + no p wave in between QRS complexes, just T wave dx? - ✔premature atrial contraction H1Ac greater than 15% predicts diabetic retinopathy. Results that show 88% of allpatients without diabetic retinopathy had a hemoglobin less than 15%.

Which of the following is the most accurate interpretation? - ✔specificity is 88% Hyperkeratotic, erythematous crusted plaque with areas of ulceration in a solid organtransplant

dx? - ✔squamous cell carcinoma If there is suspected FSGS, what is the next step after confirming it with renal biopsy? - ✔prednisone therapy

If there is suspected FSGS, what is the next step? - ✔renal biopsy In active stage, cervix must dilate at least _____ cm per hour - ✔1- In acute respiratory acidosis, pH falls by _____ for every increase of 10 mmHg in PCO2- ✔0.

In adults, the presence of a destructive bone lesion is more commonly caused by ______ disease rather than primary bone malignancy - ✔metastatic In chronic respiratory acidosis, pH falls by _____ for every increase of 10 mmHg in PCO2 - ✔0. 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 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 In patients without risk factors who are aged 40-45 can be screened for cholesterol every ____ - ✔3-5 years Kid with bed wetting problems + constipation tx? - ✔administration of an osmotic laxative Late night salivary cortisol concentration is used for diagnosing? - ✔Cushing disease Latent stage of labor (1st stage) occurs until the cervix is _____ cm dilated - ✔4- Light pink, ill-defined macules with gritty texture in face, ears and dorsal hands in afarmer

dx? - ✔actinic keratosis Low-dose overnight dexamethasone suppression test is used for diagnosing? - Cushing disease ✔

Majority of renal calculi are radioopaque and can be visualized with ____ - ✔CT Mandibular mass on 77 yr old man requires what first step? - ✔fine needle aspiration biopsy of mass Most umbilical hernias regress by ____ years of age - ✔ 3 Most umbilical hernias that are >____ cm in children >3 years of age are most likely to continue enlarging. - ✔1. Multiple myeloma is marked by proliferation of ______ B cells - ✔monoclonal Often used for surgical prophylaxis and in treatment of ksin and soft tissue infections - ✔Cefazolin Patient with afib with a history of TIA or stroke Tx? - ✔warfarin

Patient with bicarb of 25, high CO2, and low PH is likely to have _____ respiratory failure. - ✔acute Patient with bicarb of 30, high CO2, and low PH is likely to have _____ respiratory failure. - ✔chronic Patient with exercise induced asthma. Fist step? - ✔inhaled albuterol therapy Patient with juvenile idiopathic arthritis may present with what extraarticular manifestation? - ✔uveitis (screen with slit-lamp exam) Patient without afib with history of TIA or stroke Tx? - ✔aspirin Patients with HF (EF < 50%) who have AS + asymptomatic in terms of SOB on exertion, should receive what treatment? - ✔Afterload reduction Patients with severe AS with symptoms or systolic dysfunction (EF <50%) shouldreceive what tx? - ✔aortic valve replacement

Postmenopausal bleeding in 57 yr old bleeding + 2.5 cm subserosal fibroid Dx and next step? - ✔endometrial carcinoma; endometrial sampling Pregnant patient who shows signs of depression 6 weeks after giving birth dx? - ✔major depressive disorder Prevalence ratio greater than 1.0 indicates? -population making up the numerator ✔condition is more prevalent in the

Prevalence ratio less than 1.0 indicates? -population making up the denominator ✔condition is more prevalent in the

Primarily used in treatment of Gram - bacterial infections like in UTIs - ✔Gentamicin 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

Progesterone therapy in amenorrheic patients is given and withdrawn. If menses occurs after withdrawal, then the cause of amenorrhea is most likely _______ -hypothalamic-pituitary-ovarian axis ✔impaired

Risk factors for endometritis post delivery - ✔PPROM, prolonged labor, c-section, BV, GBS, manual placental removal SJS and TEN treatment? - ✔supportive care and wound management + ICU burn unit admission SSRIs in bipolar patients can be bad because? - ✔it can precipitate mania or convert depression to mania Standard of care in GI surgeries is to give periooperative abx such as? -and metronidazole (gram -, anaerobic coverage) ✔ciprofloxacin

Standard of care in surgeries such as total knee replacements but patient hascephalosporin allergy is to give periooperative abx such as? - ✔Gentamicin and/or vanc

Standard of care in surgeries such as total knee replacements is to give periooperative abx such as? - ✔cefazolin (1st and 2nd cephalosporin) Struvite and cystine calculi are ______ renal calculi - ✔radiolucent T/F: Aminoglycosides (gentamicin) are CI in pregnancy - ✔true 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: Aspartame is commonly associated with diarrhea - ✔false T/F: Aspirin and clopidogrel are anticoagulants - ✔false T/F: Basal cell carcinomas have hyperkeratotic crust - ✔false T/F: Cephalosporins have no role in treating Chlamydia - ✔true T/F: CT scan is better for nephrolithiasis than x-ray - ✔true 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: Eye exam in NF2 patients can be done annually. - ✔false T/F: Fat embolism is common in scuba divers experiencing AMS, chest pain, dyspnea and wheezing. - ✔false T/F: Forceps/vacuum delivery needs station to be at least at 0. - ✔true T/F: HDL and total cholesterol can be enough to assess cardiovascular risk. - ✔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: Hypomagnesemia is more common than hyponatremia in delirium tremens - ✔true T/F: Hyponatremia can be seen in delirium tremens - ✔true T/F: Idiopathic pulmonary hypertension presents with shortness of breath, chest discomfort on exertion, RHF, loud P2 and/or tricuspid regurg. - ✔true T/F: Initial step to controlling allergic rhinitis can include use of pillow and mattress covers - ✔true T/F: It is likely to see idiopathic pulmonary hypertension in children - ✔false T/F: LABA are the main daily treatment for chronic COPD patients. - ✔true T/F: LDL cholesterol is essential for assessing cardiovascular risk - ✔false T/F: Most significant risk factor for alzheimer's is advancing age. - ✔true T/F: Most significant risk factor for alzheimer's is genetics. - ✔false T/F: Neonate that improved with PPV can be taken off of PPV immediately after - ✔true T/F: NSAIDs increase risk for renal function. - ✔true T/F: Oral steroids are the main daily treatment for chronic COPD patients. - ✔false T/F: Osteosarcoma is most common in patients ____ years of age - ✔< T/F: Patients with chronic respiratory acidosis will retain CO2 as bicarb and therefore have increased bicarb. - ✔true

T/F: Placebo can be nixed in a clinical trial is there has been evidence of standard treatment that is readily available working as a potentially life saving treatment. - ✔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 T/F: Steroids and antihistamines can be used to prevent anaphylaxis from bee stings - ✔false

T/F: Steroids are useful in SJS patients - ✔false T/F: Steroids, beta blockers, isotretinoin, and interferons can cause medication-induced depressive disorder - ✔true T/F: Subconjunctival hemorrhage is a stable patient with no ocular pain or abnormal exam findings can be treated with observation and reassurance. - ✔true T/F: Submucosal fibroid is likely to cause postmenopausal bleeding. - ✔true T/F: Subserosal fibroid is likely to cause postmenopausal bleeding. - ✔false T/F: Support group psychotherapy is validated for depressive disorders - ✔false T/F: Unstable angina requires outpatient exercise stress test. - ✔false T/F: Unstable or worsening angina requires inpatient observation - ✔true T/F: VWD usually presents with irregular menses. - ✔false T/F: You can do forceps/vacuum delivery at a patient with fetal station of -1. - ✔false T/F:MRI of brain is needed for NF2 patients annually - ✔true The proportion with a negative test will mostly impact the _______. - ✔NPV The proportion with a positive test will mostly impact the _______. - ✔PPV The proportion with the lowest false negative rate will have the highest _____ - ✔ sensitivity

The proportion with the lowest false positive rate will have the highest _____ - ✔ specificity Tx for people who have allergies to bee stings and develop anaphylaxis? - ✔ hymenoptera venom immunotherapy (VIT) US can be useful for detecting _____ renal calculi - ✔radiolucent Vitamin deficiency associated with Roux-en-Y gastric bypass? - ✔Vitamine B What chemical can cause osmotic diarrhea, bloating, and abdominal discomfort when used in excessive quantities? - ✔sorbitol When can hyponatremia cause confusion? - ✔< Wide QRS complex without identifiable P waves + tachycardic Patient is 72 yrs old + collapsed + hx of heart disease Dx? - ✔vtach Worsening stable angina can be reclassified as? - ✔unstable angina