NBME 18

Question 1

what triggers labor

Answer 1

prostaglandins

Question 2

what is the organic PO4 level in pts with renal failure

Answer 2

INCREASED

-in clinic the pts get something to bind PO4 in order to help you pee it out

Question 3

mother who has recently given birth, complicated pregnancy, lethargic, messed up hormones

Answer 3

sheehan syndrome –> bleeding into pituitary gland

decreased prolactin, ACTH, and TSH
increased aldosterone

Question 4

eosinophils in the pee

Answer 4

acute interstitial nephritis

Question 5

lytic lesions in the bone are a hint to what associated cancer

Answer 5

carcinoma of the breast

Question 6

types of atelectasis

Answer 6

obstructive
-airway obstruction

compressive
-external compression of lung

contraction
-scarring of lung parenchyma

adhesive
-lack of surfactant

Question 7

what causes movement of the DIP joins in the hands

Answer 7

flexor digitorum profundus

Question 8

what type of cells get messed up in celiac disease

Answer 8

its an enteropathy… so enterocytes

Question 9

x-linked recessive disease (like duchenes), whatre the ddd a carrier woman will have a baby with it

Answer 9

1/4

Question 10

rule of 2s in GI

Answer 10

meckel diverticulum

• 2 times as likely in males
• 2 inches long
• 2 feet from the ileocecal valve
• 2% of the population
• presents in first 2 years of life
• may have 2 types of epithelia (gastric and pancreatic)

Question 11

vomiting levels of K, HCO3, anion gap, and pH

Answer 11

K –> decreased
HCO3 –> increased
Anion Gap –> normal
pH –> increased

Question 12

pt has neisseria meningitis then suddenly gets worse, possibly even after treatment

Answer 12

waterhouse freidrickson

• adrenal insufficiency (check ACTH levels)
• fever
• DIC
• shock

Question 13

viral particle with wheel like shape and child with fatal diarrhea

Answer 13

reovirus/rotavirus

Question 14

two options for metabolic acidosis

Answer 14

increased anion gap (MUDPILES)
Methanol (formic acid) 
Uremia 
Diabetic ketoacidosis 
Propylene glycol 
Iron tablets or INH
Lactic acidosis 
Ethylene glycol (oxalic acid)
Salicylates (late)

normal anion gap (HARDASS)
Hyperchloremia/Hyperalimentation
Addison disease
Renal tubular acidosis
Diarrhea 
Acetazolamide 
Spironolactone 
Saline infusion

Question 15

what is the congenital defect in a pt with a diaphragmatic hernia

Answer 15

pleuroperitoneal membrane

-associated with a left sided diaphragmatic hernia and bilateral renal agenesis

Question 16

antidote for cholinesterase inhibitor poisoning

Answer 16

atropine (competitive inhibitor) + pralidoxime (regenerates ache if given early)

Question 17

what type of cell is abnormal in chronic bronchitis

Answer 17

pseudostratified columnar epithelial cells

Question 18

greening reaction on blood agar

Answer 18

alpha-hemolytic strep

Question 19

why would a diabetic have diarrhea

Answer 19

motility disorder (gastroparesis diabeticorum)

Question 20

what runs along the side and in the middle of the cavernous sinus

Answer 20

side: CN 3,4,5 (1 and 2)
middle: 6

Question 21

preclude

Answer 21

stop from happening