NBME 9 Review questions and answers well illustrated.

NBME 9 Review questions and answers well illustrated. Who should receive PCV13 vaccine? - correct answers.Patients with HIV, lymphoma, leukemia, multiple myeloma, functional or anatomic asplenia, ESRD, cochlear implants, CSF leaks, hx solid organ transplant, immunodeficiencies Post-transplant lymphoproliferative disorder - correct answers.EBV (monoclonal B lymphocytes) Type of cells increased in multiple myeloma - correct answers.B cells (monoclonal spike) -- multiple myeloma is a disorder of plasma cell proliferation; plasma cells are terminally differentiated B cells, thus it is considered a B-lymphocyte malignancy Alk phos levels in hemolysis - correct answers.Normal (alk phos is elevated in the case of biliary obstruction -- hemolysis occurs before this point) Medication options for acute depression in a patient with bipolar - correct answers.Lithium, lamotrigine, quetiapine, lurasidone How to diagnose botulism - correct answers.Repetitive nerve stimulation studies (electromyography) -- improves with repeated stimulation Prevention of stroke in a patient with a fib - correct answers.Warfarin (anticoagulation) Vestibular neuronitis - correct answers.Inflammation of vestibular portion of cranial nerve VIII - commonly after viral infection Acute vertigo, nausea, vomiting, nystagmus (horizontal or rotary), gait instability -- episodic! Basilar migraine - correct answers.Begins with brainstem aura symptoms - vertigo, incoordination, tinnitus, hearing loss, diplopia, dysarthria Symptoms last only a few minutes to an hour and are followed by headache (occipital) Treatment of diaper candidiasis - correct answers.Topical nystatin JIA - female child with oligoarthritis and positive ANA titers; what should you evaluation - correct answers.Slit-lamp evaluation (uveitis is common and often asymptomatic until it has led to complications) Treatment SVT - correct answers.1 - adenosine, vagal maneuvers 2- beta blocker or calcium channel blockers if refractory *if hemodynamically unstable, immediate electrical cardioversion Next step in a patient who does not respond to PPI - correct answers.24 hour esophageal pH monitoring When is hemodialysis indicated in AKI? - correct answers.Severe acidemia, electrolyte disturbances (hyperkalemia), volume overload or uremia (N/V, AMS) Factor VIII deficiency, lab studies - correct answers.Prolonged PTT; normal everything else Pap with atypical glandular cells, next step - correct answers.Colposcopy with endocervical curettage (need to sample both cervix and endometrium) Management of secondary hypertension in hyperaldosteronism - correct answers.Spironolactone! (aldosterone receptor antagonist - diminished effects of aldosterone on renal collecting tubule, results in decreased sodium reabsorption and potassium secretion) Migraine prophylaxis - correct answers.Beta blocker (propranolol), tricyclic antidepressants and SNRIs, anticonvulsants (topiramate, valproate) Ergotamine - correct ine abortive medication Most common HIV-associated nephropathy - correct answers.FSGS Diagnosis of FSGS - correct y biopsy How old do you have to be to be diagnosed with personality disorder? - correct answers.18 USPSTF guidelines diabetes screening - correct answers.Yearly from ages 35-70 (overweight or obese) 3 year old boy with nearly absent levels of IgA, IgG, IgM; recurrent infections and viral meningitis; what is most likely diagnosis? - correct answers.X-linked agammaglobulinemia Treatment of x-linked agammaglobulinemia - correct answers.IVIG