NBME 7: Questions & Answers
Man unable to conceive, has ill defined soft masses palpable bilaterally, high in the scrotum. What is the most likely cause (Ans
- bilateral varicoceles
-hydroceles don't cause infertility DIRECT inguinal hernias DO NOT ENTER THE SCROTUM
- yo boy w/ fatigue since viral illness 3 weeks ago, gums bleeding when
- bone marrow aspiration
brushing teeth, cervical, axillary and inguinal adenopathy. hgb is 8, leukocytes are 3K and platelets are 30K. What is the next step in management-transfusion of platelets or bone marrow aspiration (Ans
patient could have a myelodysplastic syndrome, could or could not be related to the virus
A 4yo boy with a 3 day history of cough, fever, runny nose is 75th percentile for height and 10th percentile for weight. vitals are normal, exam shows clear rhinorrhea, breath sounds normal. What is the diagnosis (Ans - Upper respiratory infection
normal to have flow murmur/splitting of S2 made louder w/ inspiration
A 19 year old found standing in neighbor's living room, remains mute during questionsing. vitals are stable other than BP 160/95. Has bilateral nystagmus, constricted pupils, hypertonia, and decreased sensation to pinprick. What is the most likely substance taken (Ans - PCP
fluctuating behavior, autonomic disturbance (hypertension), nystagmus, hypertonia
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-inhalants would appear drunk w/ dilated pupils PCP apparently doesn't affect pupils. main thing is that it causes nystagmus, mutism if not aggressive
18 year old has 3 day history of fatigue and yellow eyes, family history of anemia, scleral icterus. Hgb 8.6, MCHC 38%, retic 8%, tbili 3, negative direct coombs. smear shows round RBC w/out central pallor. What would have prevented the patient's symptoms (Ans - this is spherocytosis treatment/prevention of hemolytic anemia is via splenectomy!
18 year old primigravid woman admitted for labor w/ history of genital herpes, most recent outbreak 6 weeks ago. No lesions or prodromal symptoms since and no lesions on exam. Cervix 100% effaced, 5cm
dilated, vertex -1. What should you do next: give acyclovir, amniotomy and
vaginal delivery, or c/s (Ans - amniotomy and vaginal delivery
9yo w/ low back pain for 4 months, most severe when wakes up and after physical activities. tenderness in R sacroiliac joint, paravertebral muscle spasm, decreased flexion at waste. CK normal, ESR elevated.(Ans - anklylosing spondylitis...although age isn't right (mean age of onset is 23) and hard to see bamboo spine
spondylolisthesis is the most common cause of back pain in teens
72 year old w/ indigestion while walking briskly or uphill, relieved by rest. Sx not related to eating and not relieved by antacids, normal exam. What test should you do next?(Ans - Exercise stress test--elderly, women and diabetics have atypical presentation of angina/MI
Homeless 66 year old man admitted for jaundice. Irregular eating habits, 20lb weight loss. 20 year history of alchoholism, shows signs of wasting, icteric sclerae, palmar erythema, spider angiomata. Serum Mg is 0.8.
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