NBME 7

Question 1

Tx and prevention for gout?

Answer 1

Tx: NSAIDS (ibuprofen/indomethacin), or colchicine if NSAIDS intolerable
Prevention: allopurinol

Question 2

SOB for 8hrs, inspiratory crackles, JVD and distant heart sounds, x-ray shows cardiomegaly, EKG w/ alternating amplitude of QRS, next step?

Answer 2

Pericardial window - drains pericardial effusion into pleural cavity

Question 3

23yo asymptomatic, preemployment eval, PPD 16mm, no prior PPD and no exposure, x-ray w/o abnormalities, sputum samples show no acid-fast bacilli, next steps?

Answer 3

Tx latent TB now

Question 4

16yo girl, different opinion on activities, mother does not want to confide, dad does not know all, mgmt?

Answer 4

Family therapy - all parties are not on the same page

Question 5

27yoM, unable to conceive, exam shows ill-defined soft masses palpated bilaterally, high in the scrotum, dx?

Answer 5

Bilateral varicoceles (varicoceles and infertility)

Question 6

Homeless man, jaundice, 20 year history alcoholism, low magnesium, other lab findings?

Answer 6

Decreased calcium. Alcoholism -> low mag -> low PTH -> dec calcium

Question 7

ALS EMG and nerve conduction studies findings?

Answer 7

Fibrillation potentials in multiple muscle of multiple extremities

Question 8

Serosanguineous fluid between incision staples, large amount of fluid, minimal incision tenderness and no erythema

Answer 8

Wound dehiscence (if minimal fluid than normal)

Question 9

More TB proph

Answer 9

Pneumococcal vaccine

Question 10

Digoxin toxicity?

Answer 10

Arrythmias, PVC/V-tach/V-fib, nausea/vomiting/visual symptoms, hyperK (but this question had low K)

Question 11

14yo boy, 6mo left knee pain, exacerbated by activity especially jumping. No hx of direct injury, he has grown 3 inches over the past 6 mo, older brother had similar symptoms, normal gait, range of motion of hips/knees are full and symmetric; tenderness and swelling over the left tibial tubercle, no joint effusion and knee joint is stable, MOA?

Answer 11

Repeated microfracture at the tendon site - Osgood Schlatter

Question 12

18yoF, fever, mild productive cough, sore throat, general malaise, and anorexia for 5 weeks; exudative pharyngitis w/ whitish membrane, prominent cervical lymphadenopathy, splenomegaly, dx?

Answer 12

EBV

Question 13

Least invasive management for aspiration pneumonia?

Answer 13

Elevation of head of the bed

Question 14

19yo AA man p/w 9month hx of 6-12 hr episodes intermittent watery diarrhea a/w abdl cramps and bloatoing; diarrhea after meals since 12, no other abnormalities, dx?

Answer 14

Lactose intolerance (not celiac - other deficiencies would be present)

Question 15

Flesh colored papules w/ central umbilication over face, neck, back, and chest, in adults vs kids?

Answer 15

Molloscum contagiosum - harmless virus in kids. If found in adults - considered STD -> consider HIV antibody testing

Question 16

2+ nonpitting edema, dec DTR, uninterested/forgetfullness/responds slow to questions, hyponatremia, dx?

Answer 16

Hypothyroidism (pretibial myxedema)

Question 17

Aortic dissection, pressures or HR management?

Answer 17

IV labetalol

Question 18

Hyponatremia, euvolemic, dec serum osm, inc urine osm

Answer 18

SIADH - too much ADH, body holds on to water (low serum osm) while inappropriately concentrating urine

Question 19

1st line tx for BPH (difficulty starting urinary stream and dribbling)

Answer 19

Finasteride

Question 20

Asymptomatic type 1 (sliding) hiatal hernia, tx?

Answer 20

Observation -> symptoms? then antacids or H2 receptor antagnoist -> lastly lap nissen fundoplication

Question 21

Low back pain for 4 months, present throughout day but most severe in mornin, dull ache w/ stiffness in the morning, right SI joint tenderness w/ paravertebral muscle spasm and dec flexion at waist, ESR is inc, dx?

Answer 21

Ankylosing spondylitis

Question 22

Diabetes insipidus

Answer 22

ADH not being produced (central) or kidneys unresponsive to ADH - peeing a lot, urine is dilute, this is hypovolemic hypernatremia

Question 23

57yoF, inc pain in left groin and anterior thigh over the past year, active range of motion of hip joint reporudces pain, 20 deg hip flexion contracture, ESR 20, dx?

Answer 23

Osteoarthritis

Question 24

OCP, dec risk of what?

Answer 24

Ovarian, breast, endometrial

Question 25

Lead poisoning tx?

Answer 25

Calcium disodium edetate

Question 26

Otherwise healthy 37yoM, 3 month low back pain, NSAIDs help, forward flexion is normal w/o pain, hyperextension increases pain, strength/sensation/reflexes normal; picture of lateral x-ray showing vertebral body slipping forward, dx?

Answer 26

Spondylolisthesis

Question 27

62yoW severe upper back pain, progressive weakness of both legs, tingling in legs and feet, episodes of urinary incontinence -> underwent mastectomy six months ago, bad LE muscle/sensation/brisk DTR, positibe Babinski, dx and mgmt?

Answer 27

Mets to spine, radiation therapy

Question 28

Pathophys of emphysema?

Answer 28

X-ray shows thin walled cystic spaces w/ some air-fluid levels, look for destruction and dilation of distal airways