Block 1 1. B (well-fitted shoes to avoid trauma. prophylactic antibiotics not indicated.) 2. A (clue from the stem: hyperthyroidism, irregularly irregular pulse, variation in intensity of S1) 3. C 4. E (hereditary spherocytosis) 5. B 6. E (NSAID papillary necrosis doesn't happen so fast. History of trauma makes E best answer) 7. C (DT boosters indicated after every 10 years. She has all 5 doses of DTP already, so now booster is with adult DT even if she is 16 year old.) 8. C (SIADH can happen secondary to meningitis) 9. D (Hemochromatosis) 10. A (identifiable stressor) 11. J 12. H 13. D (renal artery stenosis) 14. A (HTN with hypokalemia >> Conn's syndrome) 15. D 16. B (fixed splitting of S2) 17. 18. D (refractile body at bifurcation of retinal artery >> cholesterol emboli from the internal carotid artery atherosclerotic disease >> duplex scan of carotid artery) 19. A 20. C 21. A 22. B 23. A 24. B 25. A [Pt has a crude pincer grasp- This should have been mastered by 9-14 months to be normal] 26. E 27. C 28. C (only option that goes with restrictive disease) 29. D 30. G 31. D 32. B (fat soluble vitamin) 33. E 34. A 35. C 36. A (antibiotic prophylaxis for Chronic bacterial prostatitis) 37. F 38. A (Huntington's disease) 39. G 40. A (cyclosporine-induced hypertension) 41. E 42. B 43. E (obesity >> increased estrogen) 44. C (crossed hemiplegia) 45. B 46. F BLOCK 2 1. D (pin-point pupils >> opiates) 2. B 3. A (Lyme disease) 4. D (Granulosa cells produce excessive amounts of estrogen) 5. C 6. D 7. B (Elevating the left testicle relieves the pain >> Epidodymitis) 8. D (side effect of enalapril) 9. D (Heparin-induced thrombocytopenia. As explained by a commenter: the reason there is thrombocytopenia in HIT is because the Heparin-Platelet4 complex are attacked by IgG in the human bodies that essentially activate the platelet and thus form clots. These clots are the reason free platelets are low.) 10. C
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NBME Answer Keys
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11. B (pulsus paradoxus) 12. D 13. C (biliary colic) 14. C (Oral isotretinoin is never the first option for acne, only used when topical treatments have failed) 15. B 16. C 17. B (screening of lipid profil routinly done for every HTN patient) 18. A 19. B 20. E 21. F 22. D 23. D 24. E (white patches over the skin that become more distinct with Wood's lamp examination "ash leaf spots" >> Tuberous sclerosis) 25. D 26. I 27. B 28. E 29. B 30. D 31. E 32. B 33. B (question stem says that mother applies sunscreen 'just before she goes swimming', which is incorrect way. It should be applied at least 15-30 min before sun exposure) 34. A (Botulism) 35. A 36. D (VSD) 37. E 38. D 39. D 40. B 41. C 42. E 43. D 44. E 45. C 46. D Block 3 1. D 2. A 3. C 4. B 5. A 6. A (aldolase-B deficiency) 7. B 8. D 9. D (risk of repeated falls) 10. B (Xanthelasma >> high cholestrol) 11. E 12. B 13. D (Prinzmetal angina) 14. A 15. C (Diabetes Inspidus) 16. E 17. C (I am confused between Conversion and Malingering, because there is possibly a motive [she doesn't want to move] but it isn't clearly stated either. So on revising the question, I am now more tilted towards Conversion.) 18. G 19. C (Patient has febrile neutropenia >> IV antibiotics) 20. B 21. E (Surgery to relieve obstruction) 22. B 23. C 24. B 25. H 26. E 27. C 28. D 29. G (Cardiac tamponade)
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NBME Answer Keys
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30. A 31. D (CMV infection) 32. D 33. C (Herpes zoster) 34. C (adrenal crisis) 35. B 36. C 37. B 38. F (Isoniazid >> B6 deficiency) 39. E 40. D (Warfarin contraindicated in pregnancy) 41. E 42. F 43. D 44. B 45. C 46. D (tension pneumothorax >> decreased venous return) Block 4 1. A (breath holding spell >> reassurance) 2. A (RR shows a relationship but p value is statistically insignificant) 3. B 4. E (anaphylaxis) 5. E (high clinical suspicion with low-probability VQ scan >> angiography) 6. F 7. C (multiple areas of increased and decreased uptake >> MNG) 8. G 9. C (acute presentation makes aortic valve rupture more likely than congestive heart failure) 10. B (in a terminally ill patient, the priority is pain control) 11. A (erythema toxicum >> self-limiting condition) 12. C (MR, large testes >> fragile X syndrome) 13. E (Digoxin toxicity) 14. E 15. F (previous episodes of a sudden decline of cognitive functioning >> multiinfarct dementia) 16. C 17. E (delirium tremens) 18. D 19. J (proximal muscle weakness, polymyositis is one of the causes) 20. E 21. E 22. D (Mitral stenosis; most common cause RHD) 23. E (Mastitis: antibiotics, continue breast feeding) 24. A (Ephedrine is a sympathomimetic drug. For the treatment of hypotension during spinal anesthesia.) 25. B (Metoprolol improves mortality in heart disease) 26. F 27. D (Chronic Granulomatous disease) 28. D (S4 points towards MI) 29. D 30. A 31. C (thiazide diuretic >> gout) 32. B 33. D (GI obstruction >> NG tube first step) 34. D (HTN in young patient >> look for renal artery stenosis) 35. A (Malignancy related hypercalcemia fits best: Depression, Muscle weakness and fatigue, decreased tendon reflex, weight loss. Hypothyroidism wouldn't account for the weight loss.) 36. A 37. C (insulin and glucose >> fastest way to lower down serum K) 38. E (she is asymptomatic, no treatment at this point is indicated) 39. D (intussusception >> contrast enema both diagnostic and therapeutic) 40. C (ectopic pregnancy) 41. D 42. D 43. C 44. A (Hepatic artery complications are very common following liver transplant in children.) 45. A (http://pediatrics.aappublications.org/content/65/6/1125.abstract) 46. C
