NBME 10 EXAM LATEST ACTUAL EXAM 200
QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) |AGRADE
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? - Answer-Reassurance
This is normal thelarche and can be asymmetric
/.Order of maturation in female - Answer-Thelarche, pubarcge, growth spurt, menarche
/.27-year-old man presents with thrombocytopenia, eczema and recurrent infections -
Answer-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 - Answer-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? - Answer-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? - Answer-Transfusion associated circulatory
overload
Remember: patience with ABO incompatibility present with flank pain and hypotension
/.Treatment of transfusion associate circulatory overload - Answer-Oxygen and positive
pressure ventilation And possible directions
/.Can lead to psychosis, bizarre behavior, agitation, aggression, nystagmus and ataxia
treatment - Answer-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? - Answer-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? - Answer-Alteplase
, /.If the patient comes in with a stroke in the amount of time is unknown, with no
evidence of hemorrhage what is administered? - Answer-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: - Answer-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? - Answer-Vit B1 def
/.Immunocompetent child with cervical lymphadenitis presents with a purpleish hue, And
presence of multiple granulomas on excisional biopsy - Answer-Purpleish hue:
mycobacterium infection
/.Patient presents with a 2 cm ulcer on the foot and new mid back pain, what is the most
likely cause and what is the next best step to confirm the diagnosis? - Answer-Vertebral
osteomyelitis, MRI of the lumbar spine.
Can occur through hematogenous spread
/.Patient with a history of inflammatory joint disease are at increased risk for - Answer-
Septic arthritis
/.An x-ray showing periosteal elevation is diagnostics for osteomyelitis, what is the next
best step? - Answer-MRI before bone biopsy
/.Patient presents with generalized weakness due to a strict diet and taking laxatives in
diuretics to lose weight. What is the cause of her generalized muscle weakness? -
Answer-Loss of potassium
/.EKG demonstrating ST elevations in lead to I III and a VF is significant for right sided
heart infarction, administration of what is contraindicated in patients? - Answer-
Nitroglycerin
/.Patient with long-standing diabetes that initially was poorly controlled presents with
urinalysis showing 4+ proteins, asks for what is the mechanism of the patients increase
blood pressure - Answer-Renal parenchymal disease
/.What is the proper age for screening individuals for lipid studies - Answer-
Asymptomatic males over 35 or women over the age of 40 to 45 unless they have a
family history of hypercholesteremia or cardiovascular disease in the first degree
relative seen early
/.If you see A ulcer on the medial aspect of the leg, woody induration and dark
pigmentation, Even if the ankle brachial index is less than one - Answer-Venous
QUESTIONS AND CORRECT ANSWERS (VERIFIED
ANSWERS) |AGRADE
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? - Answer-Reassurance
This is normal thelarche and can be asymmetric
/.Order of maturation in female - Answer-Thelarche, pubarcge, growth spurt, menarche
/.27-year-old man presents with thrombocytopenia, eczema and recurrent infections -
Answer-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 - Answer-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? - Answer-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? - Answer-Transfusion associated circulatory
overload
Remember: patience with ABO incompatibility present with flank pain and hypotension
/.Treatment of transfusion associate circulatory overload - Answer-Oxygen and positive
pressure ventilation And possible directions
/.Can lead to psychosis, bizarre behavior, agitation, aggression, nystagmus and ataxia
treatment - Answer-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? - Answer-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? - Answer-Alteplase
, /.If the patient comes in with a stroke in the amount of time is unknown, with no
evidence of hemorrhage what is administered? - Answer-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: - Answer-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? - Answer-Vit B1 def
/.Immunocompetent child with cervical lymphadenitis presents with a purpleish hue, And
presence of multiple granulomas on excisional biopsy - Answer-Purpleish hue:
mycobacterium infection
/.Patient presents with a 2 cm ulcer on the foot and new mid back pain, what is the most
likely cause and what is the next best step to confirm the diagnosis? - Answer-Vertebral
osteomyelitis, MRI of the lumbar spine.
Can occur through hematogenous spread
/.Patient with a history of inflammatory joint disease are at increased risk for - Answer-
Septic arthritis
/.An x-ray showing periosteal elevation is diagnostics for osteomyelitis, what is the next
best step? - Answer-MRI before bone biopsy
/.Patient presents with generalized weakness due to a strict diet and taking laxatives in
diuretics to lose weight. What is the cause of her generalized muscle weakness? -
Answer-Loss of potassium
/.EKG demonstrating ST elevations in lead to I III and a VF is significant for right sided
heart infarction, administration of what is contraindicated in patients? - Answer-
Nitroglycerin
/.Patient with long-standing diabetes that initially was poorly controlled presents with
urinalysis showing 4+ proteins, asks for what is the mechanism of the patients increase
blood pressure - Answer-Renal parenchymal disease
/.What is the proper age for screening individuals for lipid studies - Answer-
Asymptomatic males over 35 or women over the age of 40 to 45 unless they have a
family history of hypercholesteremia or cardiovascular disease in the first degree
relative seen early
/.If you see A ulcer on the medial aspect of the leg, woody induration and dark
pigmentation, Even if the ankle brachial index is less than one - Answer-Venous
