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1
Q

Prevent post-op DVT/PE

A

Warfarin

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2
Q

Chest tightness
Nonproductive cough worse at night
B/l end-expiratory wheezes
Underlying mechanism?

A

Activation of mast cells (asthma)

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3
Q

Acute unstable angina

Next step?

A

Admit to hospital for workup

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4
Q

Acute hypercalcemia

First step in tx?

A

IV 0.9% normal saline

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5
Q

55 y/o w hx of HTN
Ripping CP
CXR - wide aortic root, dilated ascending aorta
Most likely cause?

A

Medial degeneration of the aorta - dissection

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6
Q

Suspect CVID

Next step in dx?

A

Serum Ig levels

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7
Q

Inflammatory arthropathy tx?

A

Oral NSAID

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8
Q

Perforated esophagus from upper endoscopy

Next step?

A

Operative repair of esophageal injury

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9
Q

B12 deficiency

Mechanism of anemia?

A

Impaired DNA synthesis

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10
Q

Best study to evaluate effectiveness of a new therapy

A

RCT vs standard therapy

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11
Q

Lipid surveillance for those under 40

A

Every 4-6 years

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12
Q

77 y/o F 3 months SOB on exertion
Relief with rest
EKG LBBB unchanged from 1 year ago
Next step to dx SOB?

A

exercise stress echo

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13
Q 
47 y/o M progressive DOE for 6 months 
Murmur dx'd in high school 
Slow carotid upstroke 
Systolic murmur at RSB radiates to apex 
No change with valsalva 
Paradoxical splitting of S2 
EKG LVH 
Underlying cause of murmur?
A

Congenital bicuspid aortic valve

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14
Q

32 y/o G1P1 F w b/l milky breast d/c
Stopped breastfeeding 1 year ago
Elevated prolactin, normal TSH
Tx?

A

Bromocriptine

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15
Q

Acid base disturbance in cardiogenic shock?

A

Primary metabolic acidosis (anion gap lactic acidosis)

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16
Q 
47 y/o M w 4 days of bloating and diarrhea 
watery, non bloody, foul smell 
Recent travel to Middle East 
No F 
Organsim?
A

ETEC

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17
Q

ABX tx for pyelo

A

IV ceftriaxone

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18
Q

50 y/o M massive hematemesis
Then faint, cold, sweaty
Tachycardia, low BP, low Hct
Next tx step?

A

Rapid infusion 0.9% isotonic saline (hemorrhagic shock)

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19
Q

Failure to void after removing indwelling foley

A

Post-catheter urethral inflammation with resultant acute urinary obstruction

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20
Q

Acute urinary obstruction tx?

A

Urologic emergency - place Foley to prevent bladder rupture

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21
Q 
57 y/o F in MVC 
RUE swelling and crepitus 
Extends DIP and PIP joints
Can't extend MCP of wrist 
XR mineshaft fx of humerus 
Dx?
A

Radial nerve injury

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22
Q

68 y/o M severe CP 2 hours, SOB 30 minutes
Hx DM2 and HTN
JVD, b/l crackles, S3 and S4 gallop
SpO2 88%
CXR perihilar infiltrates and enlarged silhouette
EKG ST elevations and T inversions V1-V6
Dx?

A

MI

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23
Q

65 y/o M w + routine heme occult

Next step in evaluation?

A

Colonoscopy

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24
Q

32 y/o F w polyuria, blurry vision, rapid breathing
Tachycardia and tachypnea
Glucose 783
Cause of acidosis?

A

Accumulation of B-hydroxybutyric acid (DKA)

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25
Q

27 y/o F w face and leg swelling 2 weeks
Face decreases and legs increases over day
Low albumin
Cause of edema?

A

Nephrotic syndrome

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26
Q

27 y/o M with MR 3 weeks vomiting after eating
Partially digested food and weight loss
Area of scalp alopecia
Dx and tx?

A

Gastric bezoar

Supportive tx w EGD or surgery for removal

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27
Q

37 y/o M w F and rash for 2 days after 6 weeks of Nafcillin for staph endocarditis
UA findings?

A

2+ protein, WBC’s, eosinophils (acute interstitial nephritis)

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28
Q

23 y/o M w 2 months of pain and swelling above R knee
Hx retinoblastoma in infancy tx w enucleation
Elevated Alk phos
XR lytic lesion with periosteal new bone at margins
Dx?

A

Osteosarcoma

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29
Q

35 y/o F collapsed in restaurant
Tachycardic, tachypneic, low BP
Labored breathing, diffuse bronchospasm, continuous cough
Dx?

A

Anaphylactic shock

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30
Q

Post-transplant pt w tremor and glucose intolerance
Gingival hypertrophy
Drug responsible?

A

Tacrolimus, Cyclosporine (calcineurin inhibitors)

31
Q 
45 y/o F with 3 months of virilization
LNMP 4 months ago, 2 prior pregnancies 
Muscular with large clitoris 
Temporal balding 
Next step to evaluate?
A

Testosterone and DHEAS levels (rapid onset hirsutism concerning for androgen-secreting ovarian or adrenal tumor)

32
Q

46 y/o M with days of intermittent R flank pain
Decreased urine output with episodes of high output and generalized weakness
Hx of L nephrectomy after MVC years ago
Recently started Lisinopril for HTN
Cause of sx’s?

A

Urinary outflow obstruction due to renal calculi

33
Q

Paradoxical S2 split - heard during expiration, disappears during inspiration
Causes?

A

Aortic stenosis, HOCM, LBBB

34
Q

Wide fixed split S2

A

ASD

35
Q

35 y/o African American F w DOE and lightheadedness
Hx Raynaud’s and GERD
Finding on cardiac exam?

A

RV heave - pulmonary arterial HTN in CREST due to intimal hyperplasia leads to RV enlargement and R heart failure

36
Q

Increased thirst and urination
Low urine osm and spec gravity - dx?
High urine osm and spec gravity - dx?

A

Low - diabetes insipidus (ADH def or resistance)

High - diabetes mellitus (hyperglycemia, osmotic diuresis)

37
Q 
57 y/o M w 4 weeks progressive constant thoracic pain 
Worse at night when lying down 
Weight loss and fatigue 
40 year smoker 
No focal TN, FROM
Normal strength, DTR's, sensation, XR 
CBC and Cr WNL 
Next step in management?
A

Abdominal CT (concern for pancreatic cancer)

38
Q

56 y/o M w DOE, palpitations, dry cough, LE edema for 1 month
Hospitalized for MI 4 months ago
Hx HTN, DM2, HLD, asthma, gout
JVD, bibasilar crackles, LE pitting edema
EKG persistent ST elevations w deep Q waves
Dx?

A

LV aneurysm (progressive LV enlargement and dyskinetic wall)

39
Q

38 y/o F ran high-altitude marathon, nauseous at the end, vomited twice, GTC seizure
Aggressively hydrated before and during race
Confused, withdraws to pain, low Na+
Most likely cause?

A

Hypotonic fluid loading with non osmotic release of ADH

exercise-associated hyponatremia

40
Q

45 y/o M w epigastric pain and diarrhea
Hx of PUD
EDG prominent gastric folds w multiple peptic ulcers
Next step in management?

A

Serum gastrin levels (suspect gastrinoma = Zollinger Ellison)

41
Q

Isoniazid hepatotoxicity management

A

Severe - d/c drug

Mild subacute hepatic injury - continue tx w close f/u (usually self-limited)

42
Q

Chronic cough w copious yellow sputum
Sinus congestion, hemoptysis, SOB
Diffuse rhonchi and wheezes w bibasilar crackles
Bacterial exacerbations that improve w abx’s
CXR linear atelectasis
Next step to confirm dx?

A

High-resolution chest CT - bronchiectasis (bronchial thickening and dilation due to recurrent infection and inflammation)

43
Q

67 y/o M
2 days of BLE weakness and urine incontinence
Prostate CA for 2 years, pelvic mets for 6 months
Can’t lift legs, no LE DTR’s
Next step?

A

MRI of lumbosacral spine (acute cauda equina)

44
Q

72 y/o F with 1 day of F/C, cough
Strep pneumo PNA 1 year ago
Right lung base bronchial breath sounds and increased dullness/egophany
WBC 87K with 82% lymphocytes
Sputum gram stain - G+ lancet diplococci
Confirm deficient host defenses?

A

Quantitative immunoglobulin assay (CLL)

45
Q

Greatest RF for IPH

A

HTN

Lisinopril most likely to reduce risk of recurrent IPH

46
Q

Treatment for choledocolithiasis

A

ERCP with sphincterotomy followed by cholecystectomy

47
Q

72-hour test for fecal fat = 12 g/d (2-6)
D-xylose absorption 4 mg/dL (25-40)
Most likely underlying cause of malabsorption?

A

Villous atrophy in small bowel

Celiac sprue

48
Q 
57 y/o M with 3-min LOC 
Felt ill while watching tv 
Hx HTN, MI 4 years ago 
EKG - Q waves in II, III, aVF 
Most likely explanation?
A

Paroxysmal v-tach

49
Q

Slowing of left eye adduction during saccadic movement of eyes to the right
Site of lesion?

A

Left MLF

50
Q

PCOS tx if not trying to conceive

A

Weight loss, OCP’s, Metformin

51
Q

PCOS if trying to conceive

A

Weight loss, Clomiphene, Metformin

52
Q

First medication for aortic dissection?

A

Labetalol

53
Q

67 y/o M with 2 days of vomiting blood
Hx esophageal adenocarcinoma, HTN, DM2, OA, CAD
Mechanical aortic valve
Getting radiation, makes him tired, naps for hours
Strongest indication for anticoagulation?

A

Prosthetic aortic valve

54
Q

HIT treatment?

A

Switch Heparin to direct thrombin inhibitor

55
Q

Severe hypercalcemia treatment?

A

IVF, IV bisphosphonate and/or calcitonin

56
Q

HTN primarily with isolated systolic BP (increased pulse pressure)
Most critical factor in etiology?

A

Decreased vascular compliance

57
Q

58 y/o M with 3 weeks fatigue and malaise
Root canal 5 weeks ago
Hx of murmur at 19 y/o
Systolic murmur at right second space, S4, ejection click
Low hemoglobin and hemoglobinuria
Underlying cardiac abnormality?

A

Calcification of bicuspid aortic valve

aortic stenosis, risk of endocarditis after dental procedure, hemolytic anemia

58
Q

HHS
Glucose -
Osmolality -
Acidosis - Y/N

A

Glucose > 500
Osmolality > 320
No acidosis

59
Q 
20 y/o to ED with sore throat 
Hoarseness and dysphagia for 8 hours 
Appears toxic with fever 
Pharyngitis and stridor 
Next step?
A

Laryngoscopy and ET intubation

epiglottitis

60
Q

Pancreatic pseudocyst from recurrent acute pancreatitis

Next step in diagnosis?

A

ERCP for diagnostic and therapeutic function

61
Q

HIDA scan diagnosis of?

A

Acute cholecystitis

62
Q

Visualize billiard tree further after ERCP or MRCP

Placement of biliary drains/stents

A

Percutaneous transhepatic cholangiography

63
Q

Decrease risk of renal failure in chronic HTN already on Lisinopril

A

Increase dose of Lisinopril

64
Q

Carotid sinus massage to slow which arrhythmia?

A

Supraventricular tachycarrythmias (e.g. AV nodal reentrant tachycardia)

65
Q

Direct current counter shock indicated in tachyarrhythmias presenting with? (4)

A
  1. No pulse
  2. Hypotension
  3. End-organ failure
  4. AMS
66
Q

22 y/o M with 1 month malaise, F, night sweats, pruritus
Low F, anterior cervical lymph node
Diagnosis?

A

Hodgkin

67
Q

Hodgkin pel-ebstein fevers

A

Recurrent high fevers for 1-2 weeks followed be 1-2 afebrile weeks

68
Q

Specific sign for Hodgkin-associated LAD

A

Alcohol-induced pain at the enlarged lymph node

69
Q 
30 y/o M with recurrent aching right shoulder pain with reaching overhead 
Occurs at night in bed 
Most pain in the deltoid area 
Elicited by shoulder abduction 
Site of underlying condition?
A

Supraspinatous tendon

70
Q

Biceps tendon injury

A

Weak elbow flexion and forearm supination

71
Q

Two causes of renal artery stenosis and secondary HTN

A
  1. FMD in younger pt’s

2. Atherosclerosis in older pt’s

72
Q

21 y/o F with 8 days of sore throat, cough, F
Nonproductive, keeps her awake at night
Subsequent hoarseness
Crackles over right posterior lower chest
CXR - patchy lower right alveolar infiltrates with increased interstitial markings
Infection?

A

Mycoplasma PNA

73
Q

57 y/o F with ABD cramps & watery D 5 days after returning from business trip
Cough 24 hours later
20 pack-years
Diffuse crackles b/l
CXR - alveolar infiltrates in RUL, RLL, LLL
Gram stain - segmented NP’s, no organism
Infection?

A

Legionella

IM NBME (1 decks)

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