NBME PEDs 1 and 2 NBME MASTERY QUESTIONS AND ANSWERS 2022
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NBME
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NBME
17yo girl brought to ED after found lying on the street. Outside temp is 40F. En route to
hospital, paramedics administered O2 and ECG showed *J-wave*. She is lethargic and
poorly responsive to verbal commands. Temp is 32 (89.6F). Puls = 60, RR = 12, BP =
90/60. There is an odor of ethanol on he...
17yo girl brought to ed after found lying on the street outside temp is 40f en route to hospital
paramedics administered o2 and ecg s
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NBME PEDs 1 and 2 NBME MASTERY
17yo girl brought to ED after found lying on the street. Outside temp is 40F. En route to
hospital, paramedics administered O2 and ECG showed *J-wave*. She is lethargic and
poorly responsive to verbal commands. Temp is 32 (89.6F). Puls = 60, RR = 12, BP =
90/60. There is an odor of ethanol on her breath. Which of the following is most likely
explanation for the patient's cardiac findings?
a. cocaine toxicity
b. ethanol toxicity
c. hyperkalemia
d. hypocalcemia
e. hypothermia
f. increased intracranial pressure
g. MI - ANSWER-e. hypothermia (J wave = hypothermia)
A 3 yr old comes to the ED after an episode of syncope followed by a tonic-clonic
seizure. She becomes fully alert, then stops talking, closes her eyes, and has 3-4
rhythmic jerks of her arm. During this second episode, an ECG was recorded that
showed P waves at 80/min with no QRS complexes. NSR resumes shortly thereafter.
She becomes alert one minute after. Most likely diagnosis?
A) Absence seizure
B) Adams-Stokes attack
C) Adverse effect of medication
D) Breath-holding episode
E) Carotid artery trauma
F) Narcolepsy-cataplexy
G) Vasovagal episode
H) Ventricular tachyarrhythmia - ANSWER-B) Adams-Stokes attack
cause of recurrent infection - ANSWER-impaired humoral immunity
mixed metabolic acidosis and resp alkalosis - ANSWER-salicylate poisoning
patchy irregular uptake of radioisotope - ANSWER-Multinodular goiter
What is anotehr name for multinodular goiter - ANSWER-lymphocytic thyroiditis/
infiltration
14 day feevr headache and green nasal discharge in a 14 yr old kid. Post pharyngeal
wall is erythematous and covered with thin gray mucous - ANSWER-Sinusitis
,SCID has an abscence of what cells - ANSWER-T cells - leads to B cell impairment too.
Both are low
recurrent infection - bacterial, fungal and viral - ANSWER-SCID
Pt has foreign body, next step - ANSWER-bronchoscopy - take it out
kid has fever and right foot pain. itching rash stared between the second and third toes
of both feel. PLays sports in highschool. Lymphnode in groin is tender - ANSWER-
Pseudomonas - becasue he has fever.
Keep in mind that athletes foot, Trichophyton rubrum is a fungus that most common
cause of athletes foot, jock itch and ringworm but IT DOES NOT HAVE FEVER or
TENDER LYMPH NODE
2 days after delivery a male newborn has dribbling. on PE he has a 6 cm round midline
suprapubic pelvic mass - ANSWER-Posterior urethral valves
Hep A ab +
Hep B core Ab +
Hep B surface ag +
Hep B surface ab - - ANSWER-Hep A virus - immune
Hep B virus - not immune
2 yr olld boy with anorexia poor coordination and sporadic vomiting over teh last month.
Lab shows hypochromic microcytic anemia. - ANSWER-lead poisoning (not iron def)
what can TMPSMX cause on labs - ANSWER-neutropenia** ( low segmented
neutrophils)
14 yr old girl pt with suprapubic tenderness for 6 mo. She has a red smooth bulge
between the labia. Next step? - ANSWER-impreforate hymen - do cruciate incision of
the hymen
pt with anorexia is at risk for what bone morphology? - ANSWER-osteoporosis
A low pitched vibratory murmur is heard through the cardiac cycle and is most
prominent at the left upper sternal border when the child is in the sitting position. The
murmur dissapears when his neck is rotated in the sitting position - ANSWER-Venous
hymm - when he turns his head left it cuts it off. Venous hum is when he blood goes
through the internal jugular vein
, 5 ear old with fatigue for 3 weeks, acute onset of fever and chills for 2 hours. Traveled
to asia 1 month ago and *received chloroquine*. Exam shows *pallor and
splenomegaly*. HCT 22, leuko 18, platelets 80.
assay for strep
assay for heterophile
measure PT and PTT
Measure AST and ALT
thick and thin blood smears - ANSWER-thick and thin blood smears: to look for look at
blood for heinz bodies and bite cells
14 yr old girl with downs is evaluated for polycythemia vera. she has cyanosis and
clubbing. There is an S2 increased in intensity. she has a large ventricular septal defect
and a dilated main pulmonary artery. What is causing the polycythemia? - ANSWER-
Pulmonary artery HTN
fundoscopic examination shows an abscence of venous pulsations - ANSWER-
increased intercranial pressure, papillemdema, cerebral edema etc.
A 5lb 5 oz newborn is delivered at 37 weeks gestation to a 32 year old women, gravida
1 para 1, following an uncomplicated delivery. The mom has history of IV drug use and
received no prenatal care. She did not take any med during pregnancy. Rapid HIV
testing of the mother after delivery is positive. Exam of newborn shows no
abnormalities. Which of the following is the best next step to manage the newborn?
A) A 6-week course of oral AZT beginning at the 2 week exam
B) A 6-week course of oral AZT only if CD4 count decreases to less than 200/mm
C) A 6-week course of oral AZT within 12 hours after delivery
D) A 6-week course of triple antiretroviral therapy beginning at the 2 week exam
E) A 6-week course of triple antiretroviral therapy if the CD4 T count decrease to less
than 200/mm
F) A 6-week course of triple antiretroviral therapy within 24 hours after delivery -
ANSWER-C) A 6-week course of oral AZT within 12 hours after delivery
"click" or more precisely "clunk" in the hip may be detected. Ortolani maneuver and the
Barlow maneuver
main types are the result of either laxity of the supporting capsule or an abnormal
acetabulum. - ANSWER-"developmental dysplasia of the hip" (DDH) to "congenital
dislocation of the hip" (CDH)- include subluxation, dysplasia, and dislocation
U/S until 3 mo - then can do xray. xray cant visualize calcification
16 yr boy old with a painless lump in is right breast. 1cm smooth firm mass under right
nipple. no nipple or skin retraction or lymphadenopathy - ANSWER-Physiologic pubertal
development
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