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NBME 25 Test Review (Update) Questions & ANSWERs| Grade A| 100% Correct (Verified Solutions) Patient had anaphylaxis following the transfusion of fresh frozen plasma. What is the genetic deficiency?
ANSWER: IgA deficiency. Patient with this disease may have
preformed antibodies against IgA
How does sitagliptin work?
ANSWER: It is a competitive inhibitor of dipeptidyl peptidase-4
(DPP4). It prevents breakdown of GI incretins (ex: glucagon-
like peptide, GLP-1) and promote endogenous release of insulin.
ANSWER: ** DPP4 inhibitor increases endogenous insulin
What are acoustic neuromas?
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ANSWER: Vestibular schwannoma
ANSWER: Benign tumors of Schwann cells that arise from the
vestibulocochlear nerve (CN VIII).
How does acoustic neuromas cause symptoms?
ANSWER: Lesions of CN VIII leads to ipsilateral hearing loss
and positional dizziness
ANSWER: Compression of the cerebellar peduncles leads to
ipsilateral dysmetria
What is the classic presentation of pyloric stenosis?
ANSWER: Male infant 3-6 weeks of age with repeated vomiting
after feeds, dehydration, and hypochloremic, hypokalemic metabolic alkalosis
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Explain the electrolyte and metabolic derangement seen with pyloric stenosis
ANSWER: Vomiting -> Hypochloremia
ANSWER: Hypovolemia + excess bicarb -> RAAS activation -
> increase renal tubule bicarb reabsorption -> Metabolic alkalosis
ANSWER: Metabolic alkalosis + hypovolemia + increased
aldosterone -> renal potassium excretion -> hypokalemia
How does hypokalemia worsens metabolic alkalosis?
ANSWER: Hypokalemia further worsens metabolic alkalosis
via trans-cellular exchange or extracellular sodium and protons in for potassium ions
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IV drug user presents with tricuspid regurgitation and signs and symptoms of right-sided heart failure. Diagnosis?
ANSWER: Tricuspid valve endocarditis
Tricuspid valve endocarditis is associated with what organisms?
ANSWER: Staph Aureus
ANSWER: Pseudomonas
ANSWER: Candida
Describe the sound and location of tricuspid regurgitation murmur?
ANSWER: Holosystolic murmur best heard at the left lower
sternal border