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NBME Sample Questions and Answers 2023
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NBME Sample Questions and Answers 2023 A 67-year-old woman is hospitalized because of abdominal pain and persistent copious vomiting for 24 hours. Two weeks ago, she was hospitalized for treatment of... atrial fibrillation; after cardioversion to a normal sinus rhythm, she began treatment with warfarin. Yesterday, at a follow-up visit, her INR was 6 (?? normal), and her medication was discontinued. She takes no other medications. Her temperature is 37°C (98.6°F), pulse is 120/min and regular, respirations are 20/min, and blood pressure is 100/78 mm Hg. The abdomen is distended and moderately tender; there is voluntary guarding in the epigastrium (??? source of pain) There are no masses, organomegaly, or obvious hernias. Rectal examination shows no abnormalities. Test of the stool for occult blood is negative. Her hemoglobin concentration has decreased from 13 g/dL yesterday to 7.8 g/dL today. An ECG shows a normal sinus rhythm. Which of the following is the most likely explanation for this patient's abdominal symptoms? - Correct Answer Intramural hematoma of the proximal small bowel A 4-year-old boy is brought to the physician by his parents because of fatigue and irritability over the past 2 months. The family visited relatives in rural Louisiana 5 months ago where the patient ran around barefoot. The child is active and appears normal. The conjunctivae are pale. Laboratory studies include a normal leukocyte count with 15% eosinophils. A stool preparation discloses the parasite egg shown. Which of the following is the most likely cause of fatigue and irritability in this patient? - Correct Answer Microcytic anemia Two days after beginning primaquine for malaria prophylaxis, a 17-year-old African American boy is brought to the physician because of dark urine and yellowing of his eyes. His pulse is 88/min, respirations are 12/min, and blood pressure is 124/68 mm Hg. Examination shows scleral icterus and pale mucous membranes. His hemoglobin concentration is 10 g/dL. A blood smear shows erythrocyte fragments and Heinz bodies. Which of the following is the most likely explanation for these findings? - Correct Answer Deficiency of glucose 6-phosphate dehydrogenase A one-day-old newborn male is found to have hemolytic disease of the newborn. Both parents are Rh-positive, mother is positive for IgG isohemagglutinins, while father is negative. Which of the following parental blood types most likely caused this condition? - Correct Answer Mother: O and Father: AB One week after receiving 4 units of packed red blood cells for acute hemorrhage due to a gunshot wound, a 17-year-old male develops fatigue, jaundice. Laboratory results show the following:Hemoglobin 8.8 g/dL Hematocrit 28%, Serum total bilirubin 5 mg/dL Serum lactate dehydrogenase 120 U/L. Liver and kidney function tests are otherwise within normal limits. Which of the following is the most appropriate next step in diagnosis? - Correct Answer Direct and indirect antiglobulin (Coombs) tests [Show More]
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