Nbme 4 Answer Ck g111d
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NBME Answer Keys
Page 1 of 4
Step 2 CK NBME Form 4 Block 1 1. D (recurrent candidal infections >> impaired cell mediated immunity) 2. A (reassuring pattern) 3. E (normal pressure hydrocephalus >> impairment of the higher mental control of the bladder which basically inhibits the voiding reflex) 4. A (post-streptococcal acute glomerulonephritis) 5. D (hostility towards authority without gross moral violations) 6. B (high BP plus papilledema) 7. E (Multiple sclerosis) 8. C (the patient is psychotic so her demand for an abortion cannot be allowed. Haloperidol can be used in pregnancy if the benefit to the mother clearly outweighs the potential fetal risk 9. D (Crohn's disease predisposes to fibrotic strictures) 10. D (Slipped capital femoral epiphysis) 11. E (RSV infection) 12. A (facial edema + linked with history of food intake) 13. E (hint: irregular mobile mass in the right upper quadrant) 14. B (blood cultures to confirm endocarditis. Blood cultures should always be collected before antibiotic treatment begins.) 15. D (chronic pancreatitis. amylase and lipase may or may not be elevated. pancreatic enzyme replacement therapy to relieve steatorrhea.) 16. B (increased intracranial pressure plus growth retardation plus visual difficulty >> craniopharyngioma fits) 17. F (t aspiration >> first step in management of a swollen, tender t) 18. C (Osgood – Schlatter Disease: Osteochondrosis of the tibial tubercle Tx: Kaplan notes say immobilization of the knee in an extension (or ) Cylinder cast for 4 – 6 weeks. Books also mention NSAIDs as part of treatment. Apparently the correct answer on online NBME, informed by a commenter, is C - NSAIDs) 19. A (pulmonary embolism, Spiral CT scan preferred over pulmonary angiography) 20. E (restrictive pattern on PFTs) 21. B (Intussception >> contrast enema is diagnostic and therapeutic) 22. D (oral-esophageal candidiasis in HIV >> Fluconazole) 23. G (Diabetes mellitus) 24. B (Febrile neutropenia) 25. D 26. A (only 40% of original participants remain) 27. F (patient was well-controlled on Paroxetine >> best option is to resume it) 28. G (hint: masses vary in size with her menstrual cycle) 29. C 30. A 31. B (Systolic murmur radiating to carotids is classic for aortic stenosis.) 32. D (Metronidazole for pseudomembranous colitis) 33. D 34. A (L to R shunt >> increased pulmonary blood flow) 35. A (subarachnoid haemorrhage can lead to diabetes insipidus) 36. F (vitamin D supplementation is recommended for all breastfed infants) 37. D (patient fulfills criteria of Major Depression. Note the marked anhedonia >> no longer enjoys the taste of food) 38. A (von Willibrand disease) 39. A (specific trigger, doesn't fulfill criteria of Major Depression) 40. A (Urge incontinence) 41. D (N0 M0 indicates that the tumor removal was most likely complete, therefore metastatic diseases is unlikely. Plus patient's smoking history also is risk factor for primary lung cancer.) 42. A (Hemochromatosis) 43. D 44. C (Dementia) 45. B (Postal worker >> high risk for bioterrorism. Cutaneous anthrax) 46. E (ankle edema >> well known side effect of Nifedipine) Block 2 1. E (positive ANA and dsDNA) 2. C (ST elevation on ECG) 3. G (Tension pneumothorax) 4. B 5. C (Naproxen >> nephrotoxicity) 6. E 7. C (looks like alcohol withdrawal)
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5/2/2013
NBME Answer Keys
Page 2 of 4
8. D (Hydatidiform mole) 9. B (obesity, papilledema, bifrontal headaches) 10. B (hyperkalemia with ECG changes >> Ca Gluconate) 11. D (GI obstruction, first step NG decompression) 12. B 13. A 14. A (2 year h/o productive cough >> Chronic Bronchitis. O2 sat: 90% >> Blue Bloater) 15. A (smoking is a contraindication for Os) 16. C (Foreign body ingestion >> bronchoscopy) 17. M 18. C (Isoniazid neurotoxicity preventable by istration of B6) 19. B (hyperglycemia can cause hyponatremia) 20. E (elderly patient, hematocrit too low, transfuse RBC. We don't use 5% Dextrose water or 0.45% saline for resuscitation, we use 0.9% Saline, which isn't given among options) 21. A (oral & genital ulcers plus erythema nodosum) 22. C (Erysipelas) 23. D (MRI shows a mass obstructing CSF outflow from the ventricles. Choice E is wrong. Choroid plexus papilloma most commonly occurs in Children, and even Choroid plexus papilloma itself can cause obstruction to CSF flow depending on its location) 24. E (cystic fibrosis) 25. B (Endometriosis. Clues >> infertility, dysparunea) 26. C 27. A 28. C (typical position of venous ulcers) 29. B (NSAID induced (pseudo)allergic reaction. Avoid aspirin) 30. C (best option) 31. A (peripheral arterial disease makes atherosclerotic process most likely) 32. E (essential tremor >> propranolol) 33. C (poorly controlled HTN >> increased risk of MI) 34. B (CA of head of pancreas) 35. D 36. E 37. C (long-standing lymphedema >> lymphangiosarcoma) 38. A (avoid permanent/prolonged catheterization wherever possible) 39. D 40. B (Nursemaid's elbow) 41. D 42. I 43. B 44. A (diffuse enlarged uterus >> adenomyosis) 45. E (pneumocystis shows bilateral infiltrates on x ray) 46. A (warm compresses would provide most quick symptomatic benefit. Compression stockings and enoxaparin therapy are valid options but would not help with the pain.) Block 3 1.B (Fragile X syndrome) 2. E (Neuroleptic Malignant Syndrome) 3. C (small cell carcinoma >> SIADH) 4. E 5. B 6. D (clue: she comes in the fall) 7. A 8. B (The most common cause of lymphangitis in humans is Streptococcus pyogenes) 9. B 10. A (neonatal tetanus) 11. D (Dextrose water is not used for resuscitation; use normal saline or ringer lactate) 12. C (selenium sulfide shampoo can be used for treatment of tinea versicolor) 13. B 14. B 15. E 16. A (look for air under the diaphragm) 17. D (It cannot be excessive Vitamin D because serum phosphorus is below normal) 18. B 19. B 20. Q (rings on Prussian blue) 21. H
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5/2/2013
NBME Answer Keys
Page 3 of 4
22. E 23. J (macular rash involving palms and soles >> think Syphilis) 24. E (referred pain to left shoulder) 25. C (blood at urethral meatus >> look for urethral injury) 26. B (Tinea capitis. Can be transmitted by direct or through sharing of combs, hats and clothing.) 27. A 28. B (septic shock) 29. C 30. A (pale mucosa, cobblestoning) 31. D (contrast nephropathy can be decreased with proper hydration) 32. E (Hirschsprung disease) 33. C 34. A (ive smoking increases the incidence of ear and throat infections in children) 35. A 36. E 37. D 38. A (Normal aging. She doesn't have dementia. MMSE score of 27 is normal.) 39. A 40. D 41. C (Juvenile rheumatoid arthritis) 42. G 43. C 44. C (Ambulatory ECG monitoring is not used to diagnose angina) 45. F (Epiglottitis) 46. B (Febrile seizure) Block 4 1. D 2. E (Mitral Stensis >> Increased pulmonary venous pressure) 3. D (Late decelerations >> fetal hypoxia, placental insufficiency) 4. D 5. C (Start HAART with CD4 below 350 and Pneumocystis prophylaxis with CD4 below 200) 6. B (Patient fulfills criteria of Major Depression. Start antidepressants.) 7. C (Polycythemia Vera) 8. E 9. C (suspicion of Mastoiditis) 10. E (clues >> pharmacist, advised to lose weight) 11. B (Epididymo-orchitis in a sexually active young male) 12. D (Acne vulgaris) 13. C 14. D (Abdominal angina. Widespread atherosclerosis makes it likely.) 15. C 16. E 17. C (Granulosa cell tumor >> excess estrogen) 18. C (Acute poststreptococcal glomerulonephritis >> low C3) 19. A (Hereditary Angioedema. C4 is also decreased in Hereditary Angioedema, but C1 Estrase Inhibitor's deficiency is the primary pathophysiology. So while C4 is also the correct answer, I believe we should prefer C1 Estrase Inhibitor given the causative role it plays in the disease. ) 20. E 21. A (Alzheimer's dementia >> decreased acetylcholine) 22. A (dry mucous membrances, dilated pupils, flushed appearance) 23. A (Doxorubicin >> cardiotoxicity) 24. E 25. B (patient most likely stopped taking prednisone) 26. G 27. F 28. B 29. B 30. E 31. B 32. E (her rising PCO2 indicates impending respiratory failure) 33. B 34. D 35. C (Pelvic Inflammatory Disease) 36. F 37. A 38. G (Myasthenia gravis) 39. F (obstructive sleep apnea) 40. E
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5/2/2013
NBME Answer Keys
Page 4 of 4
41. A (vegetarian diet predisposes her to B12 deficiency) 42. D 43. B 44. G (buzzword: bag of worms) 45. C (embolism of cardiac myxoma) 46. B
http://nbmeanswerkeys.blogspot.ca/
5/2/2013
Page 1 of 4
Step 2 CK NBME Form 4 Block 1 1. D (recurrent candidal infections >> impaired cell mediated immunity) 2. A (reassuring pattern) 3. E (normal pressure hydrocephalus >> impairment of the higher mental control of the bladder which basically inhibits the voiding reflex) 4. A (post-streptococcal acute glomerulonephritis) 5. D (hostility towards authority without gross moral violations) 6. B (high BP plus papilledema) 7. E (Multiple sclerosis) 8. C (the patient is psychotic so her demand for an abortion cannot be allowed. Haloperidol can be used in pregnancy if the benefit to the mother clearly outweighs the potential fetal risk 9. D (Crohn's disease predisposes to fibrotic strictures) 10. D (Slipped capital femoral epiphysis) 11. E (RSV infection) 12. A (facial edema + linked with history of food intake) 13. E (hint: irregular mobile mass in the right upper quadrant) 14. B (blood cultures to confirm endocarditis. Blood cultures should always be collected before antibiotic treatment begins.) 15. D (chronic pancreatitis. amylase and lipase may or may not be elevated. pancreatic enzyme replacement therapy to relieve steatorrhea.) 16. B (increased intracranial pressure plus growth retardation plus visual difficulty >> craniopharyngioma fits) 17. F (t aspiration >> first step in management of a swollen, tender t) 18. C (Osgood – Schlatter Disease: Osteochondrosis of the tibial tubercle Tx: Kaplan notes say immobilization of the knee in an extension (or ) Cylinder cast for 4 – 6 weeks. Books also mention NSAIDs as part of treatment. Apparently the correct answer on online NBME, informed by a commenter, is C - NSAIDs) 19. A (pulmonary embolism, Spiral CT scan preferred over pulmonary angiography) 20. E (restrictive pattern on PFTs) 21. B (Intussception >> contrast enema is diagnostic and therapeutic) 22. D (oral-esophageal candidiasis in HIV >> Fluconazole) 23. G (Diabetes mellitus) 24. B (Febrile neutropenia) 25. D 26. A (only 40% of original participants remain) 27. F (patient was well-controlled on Paroxetine >> best option is to resume it) 28. G (hint: masses vary in size with her menstrual cycle) 29. C 30. A 31. B (Systolic murmur radiating to carotids is classic for aortic stenosis.) 32. D (Metronidazole for pseudomembranous colitis) 33. D 34. A (L to R shunt >> increased pulmonary blood flow) 35. A (subarachnoid haemorrhage can lead to diabetes insipidus) 36. F (vitamin D supplementation is recommended for all breastfed infants) 37. D (patient fulfills criteria of Major Depression. Note the marked anhedonia >> no longer enjoys the taste of food) 38. A (von Willibrand disease) 39. A (specific trigger, doesn't fulfill criteria of Major Depression) 40. A (Urge incontinence) 41. D (N0 M0 indicates that the tumor removal was most likely complete, therefore metastatic diseases is unlikely. Plus patient's smoking history also is risk factor for primary lung cancer.) 42. A (Hemochromatosis) 43. D 44. C (Dementia) 45. B (Postal worker >> high risk for bioterrorism. Cutaneous anthrax) 46. E (ankle edema >> well known side effect of Nifedipine) Block 2 1. E (positive ANA and dsDNA) 2. C (ST elevation on ECG) 3. G (Tension pneumothorax) 4. B 5. C (Naproxen >> nephrotoxicity) 6. E 7. C (looks like alcohol withdrawal)
http://nbmeanswerkeys.blogspot.ca/
5/2/2013
NBME Answer Keys
Page 2 of 4
8. D (Hydatidiform mole) 9. B (obesity, papilledema, bifrontal headaches) 10. B (hyperkalemia with ECG changes >> Ca Gluconate) 11. D (GI obstruction, first step NG decompression) 12. B 13. A 14. A (2 year h/o productive cough >> Chronic Bronchitis. O2 sat: 90% >> Blue Bloater) 15. A (smoking is a contraindication for Os) 16. C (Foreign body ingestion >> bronchoscopy) 17. M 18. C (Isoniazid neurotoxicity preventable by istration of B6) 19. B (hyperglycemia can cause hyponatremia) 20. E (elderly patient, hematocrit too low, transfuse RBC. We don't use 5% Dextrose water or 0.45% saline for resuscitation, we use 0.9% Saline, which isn't given among options) 21. A (oral & genital ulcers plus erythema nodosum) 22. C (Erysipelas) 23. D (MRI shows a mass obstructing CSF outflow from the ventricles. Choice E is wrong. Choroid plexus papilloma most commonly occurs in Children, and even Choroid plexus papilloma itself can cause obstruction to CSF flow depending on its location) 24. E (cystic fibrosis) 25. B (Endometriosis. Clues >> infertility, dysparunea) 26. C 27. A 28. C (typical position of venous ulcers) 29. B (NSAID induced (pseudo)allergic reaction. Avoid aspirin) 30. C (best option) 31. A (peripheral arterial disease makes atherosclerotic process most likely) 32. E (essential tremor >> propranolol) 33. C (poorly controlled HTN >> increased risk of MI) 34. B (CA of head of pancreas) 35. D 36. E 37. C (long-standing lymphedema >> lymphangiosarcoma) 38. A (avoid permanent/prolonged catheterization wherever possible) 39. D 40. B (Nursemaid's elbow) 41. D 42. I 43. B 44. A (diffuse enlarged uterus >> adenomyosis) 45. E (pneumocystis shows bilateral infiltrates on x ray) 46. A (warm compresses would provide most quick symptomatic benefit. Compression stockings and enoxaparin therapy are valid options but would not help with the pain.) Block 3 1.B (Fragile X syndrome) 2. E (Neuroleptic Malignant Syndrome) 3. C (small cell carcinoma >> SIADH) 4. E 5. B 6. D (clue: she comes in the fall) 7. A 8. B (The most common cause of lymphangitis in humans is Streptococcus pyogenes) 9. B 10. A (neonatal tetanus) 11. D (Dextrose water is not used for resuscitation; use normal saline or ringer lactate) 12. C (selenium sulfide shampoo can be used for treatment of tinea versicolor) 13. B 14. B 15. E 16. A (look for air under the diaphragm) 17. D (It cannot be excessive Vitamin D because serum phosphorus is below normal) 18. B 19. B 20. Q (rings on Prussian blue) 21. H
http://nbmeanswerkeys.blogspot.ca/
5/2/2013
NBME Answer Keys
Page 3 of 4
22. E 23. J (macular rash involving palms and soles >> think Syphilis) 24. E (referred pain to left shoulder) 25. C (blood at urethral meatus >> look for urethral injury) 26. B (Tinea capitis. Can be transmitted by direct or through sharing of combs, hats and clothing.) 27. A 28. B (septic shock) 29. C 30. A (pale mucosa, cobblestoning) 31. D (contrast nephropathy can be decreased with proper hydration) 32. E (Hirschsprung disease) 33. C 34. A (ive smoking increases the incidence of ear and throat infections in children) 35. A 36. E 37. D 38. A (Normal aging. She doesn't have dementia. MMSE score of 27 is normal.) 39. A 40. D 41. C (Juvenile rheumatoid arthritis) 42. G 43. C 44. C (Ambulatory ECG monitoring is not used to diagnose angina) 45. F (Epiglottitis) 46. B (Febrile seizure) Block 4 1. D 2. E (Mitral Stensis >> Increased pulmonary venous pressure) 3. D (Late decelerations >> fetal hypoxia, placental insufficiency) 4. D 5. C (Start HAART with CD4 below 350 and Pneumocystis prophylaxis with CD4 below 200) 6. B (Patient fulfills criteria of Major Depression. Start antidepressants.) 7. C (Polycythemia Vera) 8. E 9. C (suspicion of Mastoiditis) 10. E (clues >> pharmacist, advised to lose weight) 11. B (Epididymo-orchitis in a sexually active young male) 12. D (Acne vulgaris) 13. C 14. D (Abdominal angina. Widespread atherosclerosis makes it likely.) 15. C 16. E 17. C (Granulosa cell tumor >> excess estrogen) 18. C (Acute poststreptococcal glomerulonephritis >> low C3) 19. A (Hereditary Angioedema. C4 is also decreased in Hereditary Angioedema, but C1 Estrase Inhibitor's deficiency is the primary pathophysiology. So while C4 is also the correct answer, I believe we should prefer C1 Estrase Inhibitor given the causative role it plays in the disease. ) 20. E 21. A (Alzheimer's dementia >> decreased acetylcholine) 22. A (dry mucous membrances, dilated pupils, flushed appearance) 23. A (Doxorubicin >> cardiotoxicity) 24. E 25. B (patient most likely stopped taking prednisone) 26. G 27. F 28. B 29. B 30. E 31. B 32. E (her rising PCO2 indicates impending respiratory failure) 33. B 34. D 35. C (Pelvic Inflammatory Disease) 36. F 37. A 38. G (Myasthenia gravis) 39. F (obstructive sleep apnea) 40. E
http://nbmeanswerkeys.blogspot.ca/
5/2/2013
NBME Answer Keys
Page 4 of 4
41. A (vegetarian diet predisposes her to B12 deficiency) 42. D 43. B 44. G (buzzword: bag of worms) 45. C (embolism of cardiac myxoma) 46. B
http://nbmeanswerkeys.blogspot.ca/
5/2/2013
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