NBME CBSE Form 9 Latest Version/ NBME CBSE Form 9 Actual Exams and Study Guides/ NBME CBSE Form 9 (3 Versions) ( Questions and Answers)/ NBME CBSE EXAM
pt who had an organ transplant (or stem cell transplant) present with left-sided face & UE weakness and MRI of brain shows mass ( can be other places outside LN). biopsy of lesion shows proliferation of monoclonal B lymphocytes.
which virus is the causes? -------- Correct Answer -------- Epstein-Barr virus
- can cause post-transplant lymphoprolferative disorder in pts on immunosups for organ
- to treat reduce dosage of immunsupreesants they are on , can add rituximab.
transplant
What are the levels of Indirect Bilirubin, Lactate dehydrogenase, alk phos, during hemolysis? -------- Correct Answer -------- indirect bilirubin and LD increased alk phos normal ( this would be increased in biliary obstruction, which this not)
what is the drug to treat acute dystonia from antipsychotics (2) -------- Correct Answer --- ----- 1) benztropine 2) diphenhydramine these are anticholinergics
- drugs that are the best for bipolar depression ( key depression) -------- Correct Answer
-------- 1) lithium 2) lamotrigine 3) quetiapine 4) lurasidone
next best step in diagnosing Botulism -------- Correct Answer -------- repetitive nerve stimulation study - will show low amplitude that improves with repeated stimulation
what drug should you pt with afib to prevent thromboembolic recurrent strokes -------- Correct Answer -------- warfarin(anticoagulant)
- note, aspirin and clopidogrel(antiplatlets) are given to those without afib who had
TIA/stroke, to prevent recurring stroke
pt with constant vertigo, horiz nystagmus. diagnosis? -------- Correct Answer -------- vestibular neuronitis
differentials- Meniere's dz: episodic tinntis, vertigo, hearing loss
first line tx for mile/moderate acne vulgaris -------- Correct Answer -------- topical retinoid
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pt with stable supraventricular tachycardia (photo in iPad, very fast HR )should be managed with what (2) -------- Correct Answer -------- 1)adenosine or 2) vagal manuever
- only if refractory can do beta blocker, CCB
-if hemodynamically unstable, cardioconversion
pt with DVT, legs show brownish-red hyperperpigmentation, edema , tenderness.diagnosis? -------- Correct Answer -------- postphlebotic syndrome/postthrombotic syndrome -this is chronic venous insufficiency -
Next best initial step in the management of MALT lymphoma -------- Correct Answer ----- --- antiobiotics
- b/c MALT lymphoma is usually ass. with infECTION of gastric mucosal lymphoid tissue
due to h.pylori
a pt on PPI for heartburn still has no relief, what's NBSIM? -------- Correct Answer -------- 24-hour esophageal pH monitoring
- this is the gold standard fordiagnoising GERD, would detect increased acid
- adding H2 blocker not an answer, bc is less effective than PPI
concentrations in distal esophagus
alcoholic hepatitis can cause cholestasis, which causes which kind of sig. labs? -------- Correct Answer -------- - increased bilirubin , alk phos, and gamma-glutamyltransferase ( b/c of damage to bile duct walls)
what could help a diabetic pt with diabetic neuropathy prevent food trauma when at home -------- Correct Answer -------- wearing shoes when standing or walking ( to prevent injury) -better answer than daily foot checks by pt- by then its to late injury has already occurred
what is one way to help an obese pt that is unable to change their eatingbheavior, that is present with parents at the app -------- Correct Answer -------- involve the pt's parents in the treatment of his obesity and schedule regular fu appointments
- only then after, if this fails, can try mertformin
define disability- adjusted life years (DALY) -------- Correct Answer -------- this is a metric of overall disease burden that takes into account not only the the years of life caused by death but also the years of healthy life lost because of disability ( so both morbidity & mortality)
Hemophilia B is a deficincny in which factor -------- Correct Answer -------- factor 9
- labs= elevated PTT ( same with hemophilia A, factor 8 deficiency
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what are 2 drug classes that can treat BPH? -------- Correct Answer -------- 1) alpha 1 blockers ( CI in pt with orthostatic hypotension tho!!, see if in question stem 2) 5 alpha reductase inhibitors ( eg finasteride)
systemic sclerosis pt with non healing ulcer on toe. the bone is also visible. culture grows staph aureus NBSTIM? -------- Correct Answer -------- amputation of toe
- pt has osteomyelitis due to the ulcer
what are some drug classes ( 4) used for prophylaxis of migraines -------- Correct Answer -------- 1) beta blockers like propranolol, metoprolol) 2) Tricyclic antidepressants 3)SNRI's 4) antieplileptics like topiramate, valproate (abortive- ergotamine & sumatriptan (duh)
NBSIM of HIV pt with nephrotic syndrome ? -------- Correct Answer -------- renal biopsy , to confirm diagnosis
- pt has nephrotic syndrome= edema , proteinuria (4+ protein).
- he specifically has focal segmental glomerulosclerosis
pt with 2 day hx of fever, swelling, warmth and redness on right forearm. 6 hrs ago she saw red streaks extending from forearm to elbow. epitrochlear LN's are enlarged. tender to palpation.dx? -------- Correct Answer -------- lymphangitis
- normally caused by infection, or can be caused by malignancy of inflamm conditions
- start distally and then progress proximally toward the draining ln and causes
lymphadenopathy.
pt in accident, hypotensive and unchanged with lactated ringer solution. ecchymosis over left 6th and 7th intercostal spaces at midaxillary line. abdominal distention.would the next appropriate step for diagnosis be CT scan of the abdomen or exploratory laparotomy? -------- Correct Answer -------- exploratory laparotomy- to repair injury or remove spleen -this pt has a splenic laceration, commonly injured in a abdominal trauma. note that he's hemodynamically unstable -CT scan not answer, pt not stable enough for more diagnostic tests
o50 yo man , after he got a organ transplant 1 week ago he has been crying and feeling hopeless, worries he will never get better. on mental status examination he is sad and frequently crying, but he looks forward to visits from family. NBSIM? -------- Correct Answer -------- supportive psychotherpy
- talk therapy
- SSRi not answer b/c these symp don't meet dx of MDD of > 2 weeks and 5+ symp
- he is demenstating a normal response to a difficult situation. his reaction is
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proportionate to the stressor so this is nt adjustment disorder