Lessons from FORM 5 NBME

Question 1

Is a disorder of RBC membrane proteins that limits the ability of the cell to confrom when passing through small capillary beds

Answer 1

hereditary spherocytosis

Question 2

Hereditary spherocytosis results in _____________________ anemia caused by extravascular hemolysis

Answer 2

normocytic hemolytic anemia

Question 3

A ________________________ will reduce the degree of premature RBC consumption in a pt with hereditary spherocytosis

Answer 3

SPlenectomy

Question 4

_____________________ occurs post transfusion because of the presence of preformed antibodies to donor leukocyte antigens and occasionally from cytokines in the plasma component of the transfused sample. This can range from mild to severe.

Answer 4

Febrile Nonehemolytic transfusion reaction

Question 5

_______________ occurs when an abnormal fraction of hemoglobin in the blood exists in the ferric form

Answer 5

Methemoglobinemia

Question 6

A pt is undergoing a cholangiopancreatography with benzocaine spray for analgesia. A few minutes into the procedure she becomes mildly confused and cyanotic. Why would oxygen and administration of methylene blue improve her condition?

Answer 6

Question 7

Nuchal rigidity in the setting of a brain bleed should point to a hemorrhage where?

Answer 7

Subarachnoid

Question 8

Reflex observed in the setting of increased intracranial pressure often in the setting of impending herniation

Answer 8

cushings reflex

Question 9

Immediate treatment to decrease ICP inlcludes administration of _________________ and _________________, hyperventilation, and elevation of the head.

Answer 9

Mannitol and hypertonic saline

Question 10

______________ commonly presents with symptoms of hearing loss, vertigo, and ataxia. Often slow onset and pregressive over a subacute to chronic period.

Answer 10

Acoustic neuroma, vestibular schwannoma

Question 11

Has grown over time.

Answer 11

Cavernous hemangioma

Question 12

Septic arthritis treatment includes IV antibiotics plus ______________________

Answer 12

surgical incision and drainage

Question 13

Someone with a bicuspid aortic valve is at increased risk for aortic stenosis why?

Answer 13

Calcification of the valve overtime as it is a pathological consequence of mechanical stresses on heart valves and results from repetetive microtrauma.

Question 14

Firstline antihypertensive medication used to decrease BP in the setting of presumed aortic dissection

Answer 14

labetolol

Question 15

_______________- ulcers result from repetetive trauma or compression in areas of impaired sensation. These ulvers are commonly seen overlying bony prominences and in cases of peripheral neuropathy from DM.

Answer 15

Neurotrophic ulcer

Question 16

Why is arteriography indicated after reduction of knee dislocation?

Answer 16

Posterior knee dislocation is highligh associated with arterial injury and additional studies are indicated to prevent delay in dx and tx.

Question 17

terminal ileum inflammation

Answer 17

crohn

Question 18

________________-oma cases chronic and profound watery diarrhea, electrolyte disturbances including hypokalemia, hypercalcemia, achlorhydria, alkalosis, flushing, and vasodialation.

Answer 18

VIPoma

Question 19

How can you tell the difference between a VIPoma versus a glucagonoma vs insulinoma?

Answer 19

So they actually present quite differently.
VIPoma youll have diarrhea and facial flushing and electrolyte disturbances whereas glucagonoma will present with diabetes and a pareneoplastic rash like necrolytic migratory erythma, and weight loss. Insulinoma is sort of nonspecific. Pts will have symptoms of hypoglycemia/hyperglycemia and are often exacerbated by periods of fasting or exercise.

Question 20

A zenker diverticulum occurs in the ____________, just above the level of the cricopharyngeus muscle

Answer 20

hypopharynx

Question 21

Mechanism of formation includes an uncoordinated swallowing mechnism which results in muscle spasms of the cricopharyngeus

Answer 21

zenker (pharngoesophageal) diverticulum

Question 22

pharngoesophageal diverticulum

Answer 22

zenker

Question 23

A drunk comes in vomitting blood and you see varices and an ulcer on EGD. Pt BP is 90/40, pulse 130, and pt is dizzy. What is the most appropriate next step?

Answer 23

IV FLUIDS AND BLOOD TRANSFUSION

Placement of a transjugular intrahepatic portal shunt would be AFTER YOU GET THEM STABILIZED

You didnt address the immediate life threatening hypovolemia/hemoorhagic shock

Question 24

Answer 24

COFFEE BEAN= SIGMOID VOLVULUS

Question 25

What would you expect on labs for mesenteric ischemia?

Answer 25

leakocytosis and increased lactate

Question 26

What can we give in the setting of exocrine pancreas insufficiency

Answer 26

Pancrelipase

Question 27

This is just so you remember this exists, you werent exactly wrong but you werent right either

Answer 27

Question 28

Most common type of nephro/ureterolithiasis

Answer 28

calcium oxalate

Question 29

Having crohn disease increases a pt’s risk for what kind of nephrolithiasis formation?

Answer 29

CALCIUM OXALATE because their condition increases the absorption of oxalate!!!!!!!!

Question 30

Why might someone with crohn disease be at increased risk for nephrolithiasis

Answer 30

because they have increased absorption of calcium oxalate

Question 31

most common cause of unliateral bloody nipple discharge

Answer 31

intraductal papilloma

Question 32

A pt with BRCA1 mutation wants to decrease their risk of cancer but does not wish to undergo surgery. Why would you NOT recommend simply doing tamoxifen therapy?

Answer 32

Tamoxifen is good for the prevention of breast cancer (not as good as mastectomy) but it has been hypothesized to increase the risk for ovarian cancer throught the development of ovarian cysts.

Question 33

What is a sure fire way to decrease a pt’s risk of cancer in the setting of someone who has BRCA1 mutations?

Answer 33

Bilat mastectomy and oophorectomy.

Question 34

Why do we see secondary hyperparathyroidism in pts with end stage renal disease?

Answer 34

Decreased excretion of phsophate leads to hyperphosphatemia leading to hypocalcium leading to upreg of PTH

Question 35

what do we give to pts with a pheo to prevent hypertensive crisis?

Answer 35

Phenoxybenzamine, an irreversible alpha adrenergic blocker

Question 36

Why is pitutitary adenoma associated with bitemporal hemianopsia?

Answer 36

Because of its proximity to the optic chiasm.

Question 37

you didnt get this wrong, im just putting this here to remind you of such things

Answer 37

Question 38

What kind of fluids do we give in the setting of burns?

Answer 38

ISOTONIC CRYSTALLOID SOLUTION ONLY

NOT COLLOIDS

Question 39

Brady cardia +Hypotension versus Tachycardia +hypotension

Answer 39

Brady+hypo=neurogenic shock
tachy+hypo= hypovolemic