NBME 9 exam questions with correct answers

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 transplant - to treat reduce dosage of immunsupreesants they are on , can add rituximab. 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 4 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 tinnitus, vertigo, hearing loss first line tx for mile/moderate acne vulgaris correct answer topical retinoid pt with stable supraventricular tachycardia (photo in iPad, very fast HR )should be managed with what (2) correct answer 1)adenosine or 2) vagal maneuver - only if refractory can do beta blocker, CCB -if hemodynamically unstable, cardio conversion