NBME 10 Questions and Answers with Certified Solutions

NBME 10 Questions and Answers with Certified Solutions 11-year-old girl presents With tanner stage one of the pubic hair, she has a flat left breast and the right breast is tender and a small mass What is the best next step? Reassurance This is normal thelarche and can be asymmetric Order of maturation in female Thelarche, pubarcge, growth spurt, menarche 27-year-old man presents with thrombocytopenia, eczema and recurrent infections Wiskott-Aldrich, WAS gene, Patient comes in with ulcerative colitis Treated with prednisone mesalamine and much more and the doctor decides to add a regimen, due to the addition of the regimen what should be tested next Tuberculosis screening, due to initiation of TNF alpha inhibitor Patient with sickle cell disease comes in with vaso-occlusive crisis it is given pain control what else should be given with the pain control? Intravenous fluids Patient with a MI 10 years ago Comes to the hospital due to vomiting. The patient ends up getting a transfusion and 30 minutes later starts developing shortness of breath, what is the most likely cause? Transfusion associated circulatory overload Remember: patience with ABO incompatibility present with flank pain and hypotension Treatment of transfusion associate circulatory overload Oxygen and positive pressure ventilation And possible directions Can lead to psychosis, bizarre behavior, agitation, aggression, nystagmus and ataxia treatment PCP intoxication Treatment: IM lorazepam or Midazolam 38-year-old woman comes in due to seizures, MRI demonstrates unilateral or bilateral temporal lobe abnormalities, what is the next best step? Lumbar puncture: HSV encephalitis If a patient has stroke like symptoms occurring less than 4 1/2 half hours Without signs of hemorrhage what is administered? Alteplase If the patient comes in with a stroke in the amount of time is unknown, with no evidence of hemorrhage what is administered? Aspirin instead of alteplase Bell's palsy Presents with facial nerve palsy causing facial paralysis that doesn't spread the forehead, what is the next best step? Treatment: It's diagnose clinically, no further testing indicated Treatment: glucocorticoids and occasionally antiviral therapy Patient after gastric bypass presents with ataxia, altered mental status and opthalmoplegia including nystagmus, most likely cause? Vit B1 def Immunocompetent child with cervical lymphadenitis presents with a purpleish hue, And presence of multiple granulomas on excisional biopsy Purpleish hue: mycobacterium infection Patient