NBME 4

Question 1

Amaurosis Fugax

Answer 1

Monocular blindness due to retinal artery emboli

Question 2

TIA

Answer 2

Sudden Neuro event lasting less than 24hr with resolution

Question 3

Stroke

Answer 3

Permanent neuro deficit

Question 4

Vertebrobasilar insufficiency

Answer 4

Ischemia to brain by vertebral arteries loss of vision, ataxia, gait, vertigo

Question 5

Lymphangitis

Answer 5

Red Tender Streaks

Question 6

Lymphangitis Pathogen

Answer 6

GAS - Strep Py
Sporothrix Shenki (Garden)
Pasturella (animal)
Anthrax (animal)

Question 7

Cardiogenic Shock

Answer 7

Low CO
High SVR
High PCWP

Question 8

Septic Shock

Answer 8

High CO
Low SVR
Low PCWP

Question 9

Neurogenic Shock

Answer 9

Low CO
Low SVR
Low PCWP

Question 10

Free Air Under Diaphragm

Answer 10

Perforation
80% Proximal - Gastroduodenal
25% Distal - Colonic

Tx: Surgical Exploration

Question 11

Conn Syndrome

Answer 11

Adrenal Adenoma - Aldosterone producing adenoma

• HTN
• Headache, Fatigue, Weakness
• Polydipsia, Polyuria
• Low Renin
• Potassium less than 3.5
• Urine Potassium greater than 30
• Aldosterone >20

Tx: Laproscopic Adrenalectomy (restore k+ before surgery)
Tx: Spironolactone (K+ sparing diuretic)

Question 12

Esophageal Stricture

Answer 12

Caustic ingestion: drain opener, lye, oven cleaner
Hx: Chest Pain, cough, drooling, SOB
Tx: Endoscopic dilation, surgery, supportive

Gastric Acid Reflux -> secondary stricture

Question 13

Hepatocellular adenoma (Liver)

Answer 13

Benign tumor
OCP and Steroids
Sx: Incidental
Compress adjacent structures
Tx: Avoid OCP
Resect especially if becoming pregnant

Question 14

Focal Nodular Hyperplasia (Liver)

Answer 14

Incidental:

Central Scarring, Radiating Septations

Question 15

Liver Disease and Cancer

Answer 15

Child A 10% Mortality
Child B 30%
Child C 50% Mortality

MELD Score
Bilirubin, Creatinine, INR

Question 16

Hypocalcemia in Alcoholic

Answer 16

Hypomagnesemia: Decreased PTH and bone resistance to PTH when Mg+ is low

Question 17

Toxic Synovitis (Transient Synovitis)

Answer 17

Self limiting post infectious hip pain. URI or Diarrhea precede.
Sx: Low grade fever, Hip Pain, Limp,
Dx: WBC and ESR normal - slightly elevated

Question 18

Legg Calve Perthes

Answer 18

Idiopathic avascular necrosis of the femoral head. Age 4-9yo
XR: Crescent Sign. Increased density in affected femoral head
Tx: PT, Restriction of vigorous exercise, Surgery

Question 19

Slipped Capital Femoral Epiphysis

Answer 19

Slipping of femoral head
-Obese adolescent boy
Tx: Pin epiphysis to prevent further slippage.

Question 20

Graves

Answer 20

Autoantibodies against TSH receptors
-Retroorbital Fibroblasts

Hyperthyroidism

Question 21

Hashiomoto (Chronic Lymphocytic thyroiditis)

Answer 21

Iodine Sufficient Regions
Hypothyroidism
-Moderately enlarged nontender thyroid
-Anti Thyroid peroixdase antibodies

Question 22

Papillary Thyroid

Answer 22

Popular
Palpable lymph
Psomama bodies
Positive prognosis
Positive I 131
Pulm Mets

Question 23

Follicular

Answer 23

Female
Far Away Mets
No FNA

Question 24

Medullary

Answer 24

Men 2
Amyloid
Median Lymph Node
Modified Neck DIssection

Question 25

BiRAD

Answer 25

1) Negative - Routine Screen
2) Benign Finding - Routine Screen
3) Probably benign - Short interval follow up mammogram
4) Suspicious - Probability of CA - CNBx
5) Highly suggestive of CA - High probability - CNBx

Question 26

Men 1

Answer 26

Parathyroid
Pituitary
Pancreatic Endocrine

Question 27

Men 2A

Answer 27

Parathyroid
Pheochromocytoma
Medullary Thyroid

Question 28

Men 2B

Answer 28

Pheochromocytoma
Medullary Thyroid
Neuroma
(Marfanoid Habitus)

Question 29

Subclavian Venous Catheter

Answer 29

Risk of Tension Pneumo (perf lung behind subclavian)