NBME QUESTIONS AND ANSWERS 2022/2023

25 yo F at 27 weeks w/ severe contractions x6 hours, vaginal spotting, contractions every 2-3 mins w/ FHR 130 and no decels, cervic 1-2 cm and 70% effaced, GBS is positive. next step? - Answer - IM beclamethasone THEN later can give penicillin man w/ 15 yr hx of difficult relaxing hands after tightly gripping objects or shaking hands, difficulty releasing after gripping w/ hands. dx? - Answer - myotonic muscular dystrophy pt unable to see out of R eye since awakening 2 hrs ago. visual acuity 20/200 in R eye and 20/20 in L. R pupil poorly reactive to light. where is site of lesion? - Answer - R optic nerve 6 mo old w/ poor feeding, labored breathing, to and fro murmur in 2nd L itnercostal space, loud S2, bounding peripheral pulses, widened pulse pressure. dx? - Answer - patent ductus arteriosus recurrent lymph node infxns w/ staph a in a kid. what is dx and mechanism? - Answer - chronic granulomatous dz --> impaired phagocytic oxidative metabolism pt hyperkalemic bc missed 2 dialysis appointments. EKG w/ peaked t waves. next step? - Answer - IV calcium gluconate --> THEN can give insulin but this works within minutes hyaline casts vs WBC casts? - Answer - -WBC casts: interstitial nephritis and pyelonephritis -hyaline casts: AKI 4 yo M in MVC, RR 32 w/ grunting and restractions, hypoxic on ABG, CXR 4 hrs later shows diffuse infiltrates on R side. dx? - Answer - pulmonary contusion asymptomatic 57 yo M smoker, bruit in RUQ, no masses, BUN 23, Cr 1.4. what is cause of bruit? - Answer - accumulation of lipids in arterial wall --> renal artery stenosis 52 yo F w/ decreased libido, underwent TAH and bilateral salpingo-oophorectomy for leiomyomata uteri and menorrhagia. on hormone replacement + estrogen since sx. exam w/ moist, rugated vagina. what is cause? - Answer - decreased androgens/testosterone --> due to oophoreectomy = decreased androstenedione and DHEA = aka hypergonadotropic hypogonadism ant pituitary works ovaries don't 67 yo F w/ afib on warfarin, INR 6 so meds stopped, next day she had abdominal pain and vomiting x24 hours, Hgb 13 --> 7.8. cause? - Answer - intramural hematoma of proximal small bow