NBME CBSE Form 1 -10 Latest Version / NBME CBSE Form 1 -10 Actual Exams and Study Guide s/ NBME CBSE Form 1 -10 (20+ Version s) (1500+ Questions and Answers )/ NBME CBSE EXAM 32 yo - routine exam last office visit - 5 yrs ago appendectomy 8 yrs ago no PMHx or FHx for serious illnesses most app screening test for pt? --------- CORRECT ANSWER --------- measurement of serum cholesterol concentration according to USPTF: should screen this dude for HIV, BP, syphillis, alcohol misuse, depression, diet, hep B/C, TB, obesity, and other STDs 37 yo - 3 months of int fever and nonproductive cough > 30 lb weight loss 2 months ago: ophthalmologist tx him for L.ant uveiti s PE: gucci labs: WBC WNL; inc AST 100; inc alk phos 200 CXR: hilar adenopathy DLCO: 70% PPD neg most likely dx? --------- CORRECT ANSWER --------- sarcoidosis AI disorder - very common in African American women restrictive lung dz w/ *classic CXR patt ern - BL hilar LND* dx: biopsy of lung tissue - noncaseating granulomas common manifestations: uveitis; heart block; Bells palsy; erythema nodosum tx: steroids 37 yo - 2 days of painful bumps on R.index finger > similar episode 3 yrs ago - resolved w/o tx no PMHx; no meds SHx: resp therapist PE: tendern lesions on distal phalanx of R.index finger photo shows most app tx? --------- CORRECT ANSWER --------- oral a cyclovir therapy homegirl has herpetic whitlow HSV infection of finger caused by inoculation into open skin surface > *common in healthcare workers* painful vesicular lesions at fingertip can cause fever and axillary LND dx: Tzanck smear (multinucleate g iant cells); cx - gold standard tx: acyclovir; DO NOT DO I&D 37 yo - mult episodes of HoTN during hemodialysis PMHx: CRF PE: distended neck veins; lungs clear; distant heart tones w/o murmur/gallop echo: large pericardial effusion what physical sign is associated w/ cause of HoTN episode? --------- CORRECT ANSWER --------- paradoxical pulse Beck's triad: distant heart sounds; JVD; HoTN pericardial effusion prevents normal distension of the heart w/ filling inspiration: inc VR in RV pushes IV septum in to LV > prevents LV from filling the same > dec stroke volume for that moment = dec in sys BP symptoms similar to CHF: dyspnea on exertion, orthopnea, and PND can lead to tamponade > if effusion is rapid or if there's ventricular hemorrhage > Beck's tria d, clear lungs, and pulsus paradoxus (>10 mmHg) > tx: EMERGENT PERICARDIOCENTESIS; if can't get pt into surgery - IVF + pericardial window (make a gd hole in the pericardium) 37 yo - F/U after BP was 152/110 mmHg PMHx: mild asthma (albuterol MDI prn); levonorgestrel IUD no FHx of CVD or HTN SHx: no drugs BMI: 22 BP: 155/108 mmHg in R.upper ext; 154/106 mmHg in L. labs: WNL Na, HCO3, BUN, Cr, glucose (72); dec K, Mg; inc Cl most likely mechanism of pt's inc BP? --------- CORRECT ANSWER --------- mineralocorticoid excess homegirl has FMD renal artery stenosis = MC cause of secondary HTN > old guys will have atherosclerosis > young girls will have FMD features: sudden onset of HTN w/o FHx; dec renal function; abd br uit (RUQ/LUQ/epigastrium) dx: renal arteriogram; MRA; doppler US tx: revascularization w/ PRTA; surgery; anti -HTN (typically don't work tho) 37 yo - mole on L.leg > has it for 15 yrs FHx: uncle recently dx w/ widely met melanoma PE: 0.5 cm, slightly raised, young, brown nevus w/ symmetric borders on L.lower ext; 4 mm, smooth, moveable R.inguinal LN palp next step in dx? --------- CORRECT ANSWER --------- observation remember ABCDE for malignant melanoma I have no clue what is happening w/ the LN classic: jet black, smooth lesion on sun -exposed skin dx: never do a shave biopsy > large lesion or low suspicion - punch biopsy > small lesion or high suspicion - wide excisional biopsy tx: no tx if it has met 38 yo - low grade fever and gen rash for 4 days > cefazolin therapy for chronic osteomyelitis 100.8 F P: 100/min BP: 150/108 mmHg PE: faint diffuse maculopapular rash; back - no CVA tenderness; cardiac/pulm - gucci labs: WBC WNL (inc bands, eosinophils, m onocytes; dec lymphocytes); inc BUN, Cr UA: inc WBC (12), inc RBC (8), no RBC casts, rare WBC casts urine sediment: eosinophils most likely location of pt's lesion? --------- CORRECT ANSWER --------- renal tubule homegirl has AIN > acute int renal inf pyuria (classically eosinophils) and azotemia > occurs after administration of certain drugs (diuretics, PCN derivatives, PPIs, sulfonamides, rifampin, NSAIDs) less commonly 2/2 other processes like systemic infections or AI dz features: fever, rash, hematur ia, pyuria, and CVA tenderness; can be asymptomatic P's: Pee (diuretics), Pain -free (NSAIDs), PCNs and cephalosporins, PPIs, rifamPin 40 yo - F/U exam after PPD skin pos SHx: health -care worker current test: 17 mm after erythema and 11 mm of induration at max measurement points annual PPD over last 5 yrs - neg CXR: gucci most app next step in mgnt? --------- CORRECT ANSWER --------- administration of isoniazid +PPD screen if: > 5 mm - "immunosuppressed" (HIV/AIDs, organ transplant, steroids, close co ntacts of TB) > 10 mm - "exposed" (incarcerated/homeless, health care provider, travel to endemic areas) > 15 mm - "shouldn't be screened" pt symptomatic, pos PPD, or pos IFNy - get CXR to assess for active dz > CXR will be annual screen > if CXR neg + never been tx = INH + B6 x 9 months > if CXR pos = rule out active dz w/ AFB smears; isolate pt ~ tx w/ RIPE if AFB pos ~ tx INH + B6 x 9 m onths if AFB neg 42 yo - 6 months of mild bloating/diarrhea > 8 large, foul -smelling stools daily - difficult to flush > last 3 months - 25 weight loss; no changes in diet/appetite no PMHx; no meds no distress BMI: 17 vitals stable PE: mild temporal wast ing and beefy red tongue; abd - gucci; scattered ecchymoses and trace edema over lower ext labs: dec Hct, MCV, WBC, albumin; inc PT (INR 1.5); pos endomysial IgA Ab most likely dx? --------- CORRECT ANSWER --------- gluten -sensitive enteropathy celiac d z associated w/ IgA def HSN to gluten features: diarrhea, weight loss, abdominal distention, bloating, weakness, and fatigue can suffer via def 2/2 fat malabsorption > osteoporosis (vit D), easy bleeding (vit K), megaloblastic anemia (folate and vit B12) > beefy red tongue (aka glossitis) - Fe, folate, vit B12 def dermatitis herpetiformis = papulovesicular lesion on extensor surfaces bx in prox small bowel: flattening of villi tx: gluten -free diet 42 yo - 4 months of weakness in R.hand and 2 months of weakness in L.leg > occasional twitching of muscles in all 4 ext - thinks this is nervousness PMHx: migraines (sumatriptan) no FHx of neuro dz PE: atrophy/weakness of hands R> L, freq twitching in shoulder girdle muscles, and L.foot drop; DTR inc in all ext; Babinski pos on R.; jaw reflex brisk; speech slurred; sens exam gucci labs: inc CK 335 nerve conduction studies: gucci EMG: acute/chronic denervation in several muscles of BL upper ext and L.lower ext most likely dx? --------- CORRECT ANSWER --------- amyotrophic lateral sclerosis ALS: UMN + LMN; no sens deficit features: *prog muscle weakness*, muscle cramps/spasticity, fasciculations, impaired speech/swallowing; resp musc le weakness; weight loss/fatigue tx: riluzole other answer choices: cervical myelopathy: UMN + LMN + sens loss from degenerated area of spine; dx w/ MRI inclusion body myositis: insidious onset of weakness (can be anywhere - often quads/arm flexors); dx w / muscle bx (rimmed vacuoles, mononuclear infiltrate, no necrosis); inc CK MS: disseminated time/space; dx MRI; eyes; fatigue polymyositis: prox muscle weakness; inc CK; muscle bx (muscle necrosis w/ re+degeneration) 46 yo - mech ventilated since surgery tx of bleeding duodenal ulcer 3 wks ago 103.6F P: 110/min
