NBME CBSE REAL EXAM 200
QUESTIONS AND ANSWERS
LATEST MEDICAL
EXAMINATION
1) A 16-year-old boy is brought to the emergency department 20 minutes
after the onset of a generalized tonic-clonic seizure lasting 5 minutes. He
has hypertension treated with a calcium-channel blocking agent, but he
has not been taking his medication. On arrival, he is unarousable. His
blood pressure is 250/154mmHg. Examination shows proliferative
retinopathy. Urinalysis shows 1+ protein. Which of the following is the
most appropriate intravenous pharmacotherapy.
A. Diazoxide
B. Furosemide
C. Hydralazine
D. Lorazepam
E. Sodium nitroprusside – ANSWER -E! Very high yield question: know the
anti-hypertensives used for hypertensive emergency (eg encephalopathy)
2) A 3-year-old boy is brought to the emergency department because of a
1-day history of fever, abdominal pain, and diarrhea containing blood and
mucous. He has a history of recurrent ear infections treated with
antibiotics. He completed a 10-day course of amoxicillin-clavulanate 1 day
ago. He appears moderately ill. His temperature is 38.4C, pulse is
104/min, respirations are 20/min, and blood pressure is 100/62mmHg.
Abdominal examination shows moderate left lower quadrant tenderness
with no rebound. The remainder of the examination shows no
,abnormalities. Test of the stool for occult blood is positive. Which of the
following is the most likely causal organism?
A. Clostridium difficile
B. Salmonella enteritidis
C. Shigella sonnei
D. Staphylococcus aureus
E. Yersinia enterocolitica – ANSWER -Post-antibiotic diarrhea: C. Diff
Interesting to recognize that it can be bloody, mucus, and can occur after
amoxicillin
3) A 3-month-old boy is brought to the physician by his mother because of
a 1-day history of fever, vomiting, and fussiness. He was born at 39 weeks
gestation following an uncomplicated pregnancy and delivery. He is alert
and mildly irritable but easily consoled by his mother. His rectal
temperature is 39C, pulse is 160/min, and respirations are 38/min.
Examination of the skin shows no abnormalities. The tympanic
membranes are mildly erythematous with normal landmarks and motility.
The lungs are clear to auscultation. The abdomen is soft with no palpable
masses. The patient is uncircumcised. Laboratory studies show:
Hemoglobin 11.9 g/dL
Leukocyte count 12,200/mm3
Platelet count 240,000/mm3
Urine:
Nitrites 2+
Leukocyte esterase 3+
Results of blood and urine cultures are pending. Which of the following is
the most appropriate pharmacotherapy?
A. Cefazolin
B. Cefotaxime
C. Nafcillin
D. Penicillin
, E. Vancomycin – ANSWER -Of these, 3rd gen cephalosporins are the best
for empiric therapy. Caution with ceftriaxone (it can cause
hyperbilirubinemia – may not be a concern in this kid). Cefotaxime is the
best choice
5) A 5-year-old boy is brought to the physician because of a 4-day history
of increasing difficulty breathing. His temperature is 37.5C, pulse is
116/min, respirations are 36/min, and blood pressure is 116/80mmHg.
Examination shows jugular venous distention and mild swelling of the face
and upper extremities. There are moderate intercostal retractions.
Inspiratory and expiratory wheezes are heard bilaterally. An x-ray of the
chest shows a mass in the superior mediastinum and a large pleural
effusion in the right hemithorax. Thoracentesis yields 400mL of reddish
brown serosanguineous fluid containing numerous erythrocytes. Which of
the following is the most likely cause of the pleural effusion?
A. Congestive heart failure
B. Malignant pleural effusion
C. Nephrotic syndrome
D. Traumatic hemothorax
E. Tuberculous pleural effusion – ANSWER -Serosanguinous pleural
effusions are always malignant! This is a very classic presentation for non-
Hodgkin’s lymphoma (which is often an anterior mediastinal mass that
can cause painless LAD, SVC syndrome, and respiratory distress – per
BRS)
A 4-day-old newborn is brought to the physician b/c of a 2-day history of
progressive jaundice. He was born at 36 weeks’ gestation to a 27-year-old
woman, gravid2, para 2, following an uncomplicated pregnancy and
delivery and weighed 2608 g(5lb 12oz). The newborn’s blood group is O,
Rh-positive, and the mother’s blood group is B, Rh-positive. He has been
breast-fed since birth and receives 1 to 2 ounces of a supplemental soy
milk-based formula every day. His mother says that he has had about
seven wet diapers daily, and his stools are yellow and seedy. At discharge
2 days ago, his weight as 2495 g; he now weights 2608 g. His temp is
36.9C, pulse 138/min, respirations 32/min, BP 65/40. Exam shows scleral
icterus and jaundice from the face to the lower abdomen. The liver edge is
palpated 2 cm below the right costal margin. Laboratory studies at 36
hours of age and now show:
QUESTIONS AND ANSWERS
LATEST MEDICAL
EXAMINATION
1) A 16-year-old boy is brought to the emergency department 20 minutes
after the onset of a generalized tonic-clonic seizure lasting 5 minutes. He
has hypertension treated with a calcium-channel blocking agent, but he
has not been taking his medication. On arrival, he is unarousable. His
blood pressure is 250/154mmHg. Examination shows proliferative
retinopathy. Urinalysis shows 1+ protein. Which of the following is the
most appropriate intravenous pharmacotherapy.
A. Diazoxide
B. Furosemide
C. Hydralazine
D. Lorazepam
E. Sodium nitroprusside – ANSWER -E! Very high yield question: know the
anti-hypertensives used for hypertensive emergency (eg encephalopathy)
2) A 3-year-old boy is brought to the emergency department because of a
1-day history of fever, abdominal pain, and diarrhea containing blood and
mucous. He has a history of recurrent ear infections treated with
antibiotics. He completed a 10-day course of amoxicillin-clavulanate 1 day
ago. He appears moderately ill. His temperature is 38.4C, pulse is
104/min, respirations are 20/min, and blood pressure is 100/62mmHg.
Abdominal examination shows moderate left lower quadrant tenderness
with no rebound. The remainder of the examination shows no
,abnormalities. Test of the stool for occult blood is positive. Which of the
following is the most likely causal organism?
A. Clostridium difficile
B. Salmonella enteritidis
C. Shigella sonnei
D. Staphylococcus aureus
E. Yersinia enterocolitica – ANSWER -Post-antibiotic diarrhea: C. Diff
Interesting to recognize that it can be bloody, mucus, and can occur after
amoxicillin
3) A 3-month-old boy is brought to the physician by his mother because of
a 1-day history of fever, vomiting, and fussiness. He was born at 39 weeks
gestation following an uncomplicated pregnancy and delivery. He is alert
and mildly irritable but easily consoled by his mother. His rectal
temperature is 39C, pulse is 160/min, and respirations are 38/min.
Examination of the skin shows no abnormalities. The tympanic
membranes are mildly erythematous with normal landmarks and motility.
The lungs are clear to auscultation. The abdomen is soft with no palpable
masses. The patient is uncircumcised. Laboratory studies show:
Hemoglobin 11.9 g/dL
Leukocyte count 12,200/mm3
Platelet count 240,000/mm3
Urine:
Nitrites 2+
Leukocyte esterase 3+
Results of blood and urine cultures are pending. Which of the following is
the most appropriate pharmacotherapy?
A. Cefazolin
B. Cefotaxime
C. Nafcillin
D. Penicillin
, E. Vancomycin – ANSWER -Of these, 3rd gen cephalosporins are the best
for empiric therapy. Caution with ceftriaxone (it can cause
hyperbilirubinemia – may not be a concern in this kid). Cefotaxime is the
best choice
5) A 5-year-old boy is brought to the physician because of a 4-day history
of increasing difficulty breathing. His temperature is 37.5C, pulse is
116/min, respirations are 36/min, and blood pressure is 116/80mmHg.
Examination shows jugular venous distention and mild swelling of the face
and upper extremities. There are moderate intercostal retractions.
Inspiratory and expiratory wheezes are heard bilaterally. An x-ray of the
chest shows a mass in the superior mediastinum and a large pleural
effusion in the right hemithorax. Thoracentesis yields 400mL of reddish
brown serosanguineous fluid containing numerous erythrocytes. Which of
the following is the most likely cause of the pleural effusion?
A. Congestive heart failure
B. Malignant pleural effusion
C. Nephrotic syndrome
D. Traumatic hemothorax
E. Tuberculous pleural effusion – ANSWER -Serosanguinous pleural
effusions are always malignant! This is a very classic presentation for non-
Hodgkin’s lymphoma (which is often an anterior mediastinal mass that
can cause painless LAD, SVC syndrome, and respiratory distress – per
BRS)
A 4-day-old newborn is brought to the physician b/c of a 2-day history of
progressive jaundice. He was born at 36 weeks’ gestation to a 27-year-old
woman, gravid2, para 2, following an uncomplicated pregnancy and
delivery and weighed 2608 g(5lb 12oz). The newborn’s blood group is O,
Rh-positive, and the mother’s blood group is B, Rh-positive. He has been
breast-fed since birth and receives 1 to 2 ounces of a supplemental soy
milk-based formula every day. His mother says that he has had about
seven wet diapers daily, and his stools are yellow and seedy. At discharge
2 days ago, his weight as 2495 g; he now weights 2608 g. His temp is
36.9C, pulse 138/min, respirations 32/min, BP 65/40. Exam shows scleral
icterus and jaundice from the face to the lower abdomen. The liver edge is
palpated 2 cm below the right costal margin. Laboratory studies at 36
hours of age and now show:
