NBME 7: Questions & Answers: Latest Updated A+ Solution

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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 DIREC... T inguinal hernias DO NOT ENTER THE SCROTUM 4 yo boy w/ fatigue since viral illness 3 weeks ago, gums bleeding when 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 - bone marrow aspiration 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 -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. Serum studies are most likely to show what: change in calcitonin, change in calcium, change in TSH, change in Tx, or change in PTH (Ans - w/ weight loss and jaundice, could have cancer. Magnesium is needed for PTH. low Mg normally stims PTH secretion but SUPERlow PTH (not an answer choice) would result in Low Calcium Previously healthy 26 year old comes to the ED for SOB and painful bumps on his anterior shins. CXR shows bilateral hilar fullness. What serum abnormality is likely in the patient (Ans - THIS IS SARCOIDOSIS Pt would have hypercalcemia 47 year old w/ 6 mo history of progressive weakness beginning in R leg, spreading to other extremities. Mild difficulty swallowing solids and liquids. atrophy of R quad and both deltoids, fasciculations in both quads. Bilateral positive babinski. What would EMG and nerve conduction studies show? (Ans - This patient has ALS, death of nerves w/ UMN (babinski) and LMN (fascilations) signs. EMG shows fibrillation and fasiculation potentials in multiple muscles of multiple extremities. Motor units may be polyphasic w/ high amplitude and long duration Bulbar palsy (difficulty swallowing) is common [Show More]

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