NBME (all) Review 2

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1. 15 YO pt who normally comes in Check for delayed 12. 30 yo woman presents with low grade ANA - SLE
with her parents presents alone. puberty, talk about how fever, rash across her nose and gets
She states she is sexually active you can get pregant on worse in the sun and widespread
but knows she is not pregnant your first time even edema. What blood test would you
because she has never before you menstrated, use to screen?
menstrated. What should you tell STDs and maybe
13. 35 yo female presents with diffuse Low TSH High T3,T4
her? contraceptives
goiter and hyperthyroidism. What is
2. 16 YO female with amenorhea. Pt Androgen Insensitive TSH / T3/ T4?
lacks uterus and uterine tubes. (46XY)
14. 40 yo male on lipid lower meds. Niacin, not allergic
Has two round structures in
Develops rash, puritis and diarrhea. due to
midline just superior to labia
What drug? Is this a allergic rxn? prostaglandins (take
majora. What is the diagnosis?
what mediates this response? asprin b4 hand to
3. A 19 y/o pt presents with a defects in CN 3, 4, 6 decrease) also dec
furuncle on his philtrum and the with long term
cavernous sinous becomes therapy)
infected. What might you see?
15. 45 YO male with squamous cell HPV - 16 / 18
4. 20 YO college student presents B Cells - EBV carcinoma of the penis. He had
with LAD, fever, and mononucleosis (+) exposure to what Virus?
hepatosplenmegaly. His serum monospot. Cause of (-)
16. 48 YO female presents with Hypothyroid /
agglutinates sheep RBC's. What monospot
progressive lethargy, and extreme Hasimotos most
cell is infected? mononucleosis? CMV
cold sensitivity. What is Diag? Lab likely (High TSH low
5. 23 YO female is on rifampin for Rifampin increase values? T3/4)
TB and OCP. She gets pregnant. Cyp450 metabolism of
17. A 50 YO female complains of double Prolactinoma
Why? OCP, decreasing their
vision, amenorrhea and headaches.
effectiveness
What is likely diagnosis?
6. 23 YO male presents with one Germ Cell tumor of
18. A 50 YO pt is recovering from Abd E-Coli (UTI)
testicle. what is he at risk for? teste
surgery from 2 days ago. He has had
7. 24 YO male develops testicular via Inguinal canal to an internal catheter in place since
cancer. Mets spread where? para-aortic LN's then. He now has a fever of 100F.
Most likely organism?
8. A 25 YO pregnant woman in her Compression of IVC,
3rd trimester has normal BP when dont lie on your back. 19. A 55 y/o man undergoing tx for BPH Finasteride - 5 alpha
standing and sitting but drops to has increased testosterone and reductase inhibitor
90/50 when she lies supine. What decreased DHT as well as (also used to treat
is the condition? gynecomastia and edema. What renal stones)
medication is he on?
9. 28 y/o chemist presents with Dopamine
MPTP exposure. What 20. A 58 YO post menopausal women is Endometrial
neurotransmitter is depleted? on Tamoxifen. What is she at risk of Carcinoma
acquiring?
10. 28 YO male with normal well Infection
managed IDDM comes in with 21. A 75 yo male presents with acute PsuedoGout ->
DKA hae had recently been knee pain and swelling. X ray reveals Calcium
taking OTC cold medicine. What erosion of the joint space and calcium pyrophosphate
caused his DKA? deposits in the menisci. What is Diag?
What would be found on FNA of
11. 28 y/o woman in a MVA. Initally MMA, and temporal
joint?
feels fine then loses bone
consiousness. CT shows 22. 80 YO male. systolic cresendo Aortic Stenosis
intracranial hemorrhage that does decresendo murmur. What is the (probabley due to
not cross suture lines. What bone condition? calcified aorta)
and vessel were damaged?
23. 85 y/o man with alzheimers falls
at home and presents 3 days
later with severe headache and
vomiting. What is the diagnosis?
What is damaged?
24. An abdominal Aortic aneurysm
is most likley due to?
25. An adolescent presents with
cough and rust colored sputum.
What does gm stain show?
26. An adult male with elevated
serum cortisol and signs of
cushing syndrome undergoes
dexamethasone suppresion.
1mg does not decrease cortisol,
8mg does. What is diag?
27. An adult pt with hx of HTN
presents with sudden sharp,
tearing pain, radiating to his
back. What do you see on CXR?
28. A child presents with Cleft lip.
What process failed?
29. A CT scan of the chest shows
bilateral hilar LAD. What is the
diagnosis?
30. During a high school football
game a young athlete collapses
and dies immediately. What is
the condition?
31. A football player was kick in the
legs and suffered a damaged
medial meniscus. What else is
likely to have been damaged?
32. Hemidesmisomes, cadherin,
integrin, ICAM-1. Which joins
only cells of teh same type and
does not attach to the basement
membrane?
33. HIV (+) pt with a CD4 count of
250 presents with signs of
meningitis. CSF shows a heavily
encapsulated organism. What is
it?
34. How does rabies travel through
the CNS to cause fatal
encephalitis and seizures?
35. How does UV light damage
DNA?
Subdural hematoma 36. How is hemoglobin glycosylated Non enzymatically
bridging veins in DM to make HA1c? (slowly do to glucose
build up)
37. IV drug user presents with Chest Bacterial Endocardidits
pain, dyspnea, tachycardia, -> PE (remeber drug
Atheroscerois tachypnea. What is the condition? users get it on the right)
38. A male presents with involuntary This is hemibalismus.
Strep. Pneumo -> Gm (+) flailing of one arm. Where is the Contral lateral thalamus
diplococci lesion?
39. A man in his 40s begins to Caudate -> Huntingtons
ACTH secreting pituitary develop early dementia and
adenoma uncontrolable movements of his
upper extremities. where in the
brain do you expect to see
atrophy?
40. A man presents with pain and Most likely Gout
Widening of the swelling of the knees,
mediastinum (Dissecting subcutaneous nodules around the
Aorta) joints and achilles tendon,
equisite pain in the
metatarsophalangeal joint of his
Fusion of the maxillry
right big toe. Biopsy reveals
process with the Medial
needle like crystals.
Nasal Process. Cleft lip is
mostly a aesthetic defect 41. Monozygotic twins are delivered. This is twin transfusion,
were cleft pallate has One is pale and has a hematocrit mostly like due to
functional defiect as well of 15% the other is flushed with monochorionic, mono
hct of 55%. What caused this? who amniotic pregnancy.
Sarcoidosis
will do better? Twin with lower hct will
do better due to
"sludging" in the one
Hypertrophic with high hct.
cardiomyopathy
42. An obese woman presents with Polycystic Ovarian
amenorrhea and increased serum Syndrome (stein-
testosterone. Diag? leventhaul)
ACL, MCL
43. An older patient has blood in his Proteus
urine and renal stones. What
organism?
44. On auscultation of a patient you Mitral Regurgitation
Cadherin
hear a pansystolic murmur at the (Aortic Stenosis is not
apex with radiation to the axilla. PANsystolic)
Cause?
45. A patient cannot abduct her left CN IV (MLF tract) + CN
eye on lateral gaze but VII. Both are at level of
Cryptococcus
convergence is normal. She also Pontine
Neoformans
has difficulty smiling. Where in
the CNS is the lesion?
46. A patient has difficulty CREST: Calcinosis,
swallowing, distal cyanosis in cold Sclerodactyly,
Retrograde along
temp, anti-centromere antibodies. Telangiectasia
neurons
What other S/S will you see?
Causes Thymine Dimers
to form
47. A patient presents with photosensitivity, Renal Fxn 59. What ammino AUG - methione
arthritis, renal disease and recurrent oral (SLE) acid frequently
ulcers. She is taking Primaquine and has more coding
NSAIDS. What should be checked 2/yr? sequences in
mRNAt the
48. A patients MRI shows replacment of tissue Most likley
represented in
in the sella tursica with CSF. What is the asymptomatic
the peptide?
presentation? or defieciency
in Pituitary 60. What are the Ipsilateral UMN lesion below the lesion |
Hormones findings of Brown Ipsilateral loss of tactile, vibration and
Sequard proprioception below lesion |
49. A patient with a corticol lesion is Located on
Syndrome? Contralateral pain and temp loss below
UNAWARE of his neurologic deficiency. non dominate
lesion | ipsilateral all sension for a few
Where is the lesion? parietal Lobe
levels above lesion | LMN at level of
(usually right)
lesion
50. Post-op pt presents with Chest pain, PE
61. What are the Co2, Glycine, tetrahydrofolate / CO2
dyspnea, tachycardia, tachypnea. What is
sources of and aspartate
the condition?
Carbon for Purine
51. A pregnant woman with previous C section Placenta formation? For
is at increased risk for what pregnancy Accreta, pyrimidine?
complications? Previa
62. What cells are Leydig - Secrete; Sertoli - release of
52. A pregnant women at 16 weeks gestation Hydatifrom responsible for ABG = holds testosterone in place
presents with large abd and HTN. Diag? Mole, maintaing a high
Lab values? increased testosterone
beta HCG concentration in
53. Pt brought to ER after MVA presents with Tension the seminiferous
chest pain, dyspnea, tachycardia, Pneumothorax tubules?
tachypnea. What is the condition? most likely, 63. What Polycystic Ovarian Syndrome (stein-
could be circumstance leventhaul), physiological LH surge, low
Cardiac would cause an estrogen lvls, Turner Syndrome
Tamponade elevated LH?
too
64. What happens to Spliced (remove introns), Poly A tail, and
54. A pt has a leftward deviation of the tongue Left Medulla + mRNA before it 5' Cap
on protusion and has a right sided spastic corticospinal leaves the
paralysis. Where is the lesion? tract (happens nucleus?
before the
65. What hormones FSH, LH, ACTH, GH, prolactin, TSH
tract
come from the
decusates)
anterior pituitary?
55. A pt with poorly controlled HTN has actue Dissecting
66. What is Blocks the Na/K atpase pump. Na leaves
sharp substernal pain raidiating to the Aorta
mechanism of cell via Na/Ca counter transporter and
back. Death occurs within a few hours.
action of Cardiac increases intracellular Ca lvls = better
Diagnosis?
Glycosides contractility
56. Treatment of Acute Gout exacerbation? NSAID, (Digoxin)?
Colchicine
67. What is the best Medroxyprogesterone (injection q3
57. Two pts have the same mutation on Genetic option of birth months)
chromosome 15. but they have different Imprinting control of mental
phenotypic expressions. One has a retarted pts?
mutation from the father the other from the
68. What is the Bullet Shaped
mother. What is this an example of?
characteristic
58. A very tan child with pale mother comes in Addisons shape of rabies?
and is found to be hypotensive. What is the
condition?
69. What murmers are heard best in the Left Lateral Decubitous Position? Mitral Stenosis/ Regurg. And Left sided S3 / S4
70. What protein is involved in transporting an endocytosed vesicle from the Clatherin
plasma membrane to the endosome?
71. What substance is elevated in hydatifrom moles? beta HCG (Really high in complete, slightly elevated
in partial)
72. What type of cancer are patients with polycystic ovarian syndrome at risk Endometrial
for?
73. Where does new bone formation take place in growing long bones? Epipseal Plate
74. Where does testicular cancer first metastasize? Para Aorotic Lymph Nodes
75. Which hormones share a common alpha unit? FSH, TSH, LH, bHCG
76. While on an ACE-i a pts develops a cough. Why? what is a replacement? No Ang II = build up of bradykinn = cough. Use
AngioTensin II Receptor Blocker (ARB)
77. Why is progesterone used in combo with estrogen in hormone replacement To protect Uterus / endometrium from unregulated
therapy? hyperplasia / cancer
78. A woman involved in a accident cannot turn her head to the left and has a CN XI - accessory
right shoulder droop. What is damaged?
79. A young girl with a congeital valve dz is given penicillin prophylactically. In IV Vancomyocin and possible echo to check valves
the ER bacterial endocarditis is diag. What is next? (might need replacement)
80. A young woman is found to have short stature and shortened 4th and 5th Albrights osteodystrophy
metacarpals. What endocrine disorder is this? (Pseudohypoparathydroiism) aka body not
responsive to PTH