NBME Form 7 Practice Test

These questions are part of the practice quiz. Start practicing

• A 14-month-old child is not yet walking but can stand alone, can empty raisins from a cup, and tries to eat with a spoon. The child is at the 25th percentile in length and 30th percentile in weight. What is the most appropriate next step?
• In salicylate (aspirin) poisoning, which acid-base disturbance pattern is most characteristic?
• Three days after hospitalization for Guillain-Barré syndrome, a patient develops fever and pneumonia. Which preventive measure could have reduced the risk of aspiration pneumonia?
• A previously healthy 32-year-old pregnant woman at 15 weeks presents with 6 hours of fever and waxing/waning consciousness. Labs show anemia with schistocytes, thrombocytopenia, and renal impairment. Diagnosis?
• Empiric antibiotic for suspected MRSA in catheter-associated infection?
• In a patient with suspected pancreatitis, which serum concentration should be measured to identify hypertriglyceridemia as the cause?
• Sarcoidosis-associated hypercalcemia is due to increased activation of vitamin D by which enzyme in macrophages?
• A 24-year-old man develops shortness of breath two days after open reduction and internal fixation of a midshaft femur. He has petechial hemorrhages; ABG shows respiratory alkalosis; chest X-ray shows diffuse bilateral infiltrates. What is the most likely diagnosis?
• Which statement best describes an early feature of ankylosing spondylitis?
• After neurosurgery, a patient develops hypernatremia with high urine output and dilute urine. Which diagnosis best explains this?
• A young patient presents with facial acne. The primary structure involved in acne vulgaris is which of the following?
• A 55-year-old woman with metastatic breast cancer develops confusion and obtundation over 24 hours. Which electrolyte disturbance is most likely?
• Which description best characterizes the bone involvement in Osgood-Schlatter disease?
• An older man with transient monocular blindness has a bright yellow retinal plaque on exam. Which vessel is most likely stenosed?
• Which heart sound finding is considered physiologic in children?
• Which factor increases the risk of wound dehiscence after abdominal incisions?
• Which clinical feature is most characteristic of impetigo?
• A 50-year-old with hypothyroidism has tingling in the hands and feet, difficulty maintaining balance, pallor, fatigue, and shortness of breath. Lab shows megaloblastic anemia; the Schilling test is corrected by oral intrinsic factor. What is the most likely underlying cause?
• A 54-year-old man has 90% stenosis of the right internal carotid artery and has had left-sided weakness for the past week. What is the most appropriate management to prevent stroke?
• Where do venous ulcers classically develop?
• Clubbing of the fingers and toes in a patient with suspected bronchogenic carcinoma represents which paraneoplastic syndrome?
• Neuroleptic malignant syndrome is caused by blockade of which neurotransmitter?
• A 47-year-old man with chronic constipation and two months of blood in the stool has external hemorrhoids on examination and a positive stool occult blood test. What is the appropriate next step?
• Three days after admission for detoxification, a 32-year-old alcoholic man has ataxia, wide-based gait, bilateral abducens palsies, and horizontal nystagmus. Which vitamin deficiency is most likely?
• A 72-year-old man presents with progressive shortness of breath, jugular venous distension, basilar crackles, diminished carotid upstrokes, a systolic murmur radiating to the carotids, and an enlarged liver. The most likely diagnosis is?
• In rheumatic fever, which valve is most commonly affected, producing a murmur consistent with mitral regurgitation?
• A 52-year-old woman with two weeks of personality change, insomnia, rapid speech, and auditory hallucinations. What is the most likely diagnosis?
• In a febrile patient with diabetes who develops orthostatic hypotension and glucosuria, what explains the hypotension?
• A 4-year-old boy develops chickenpox 8 hours after visiting his newborn sister in the nursery; the mother had chickenpox prior to pregnancy. What is the recommendation for the newborn?
• An infant presents with seizures, lethargy, poor feeding, and bilateral retinal hemorrhages. The presentation is most consistent with which diagnosis?
• Which organism is most likely in this catheter infection?
• A 12-month-old with fever and recurrent infections with encapsulated organisms; which immune cell type is primarily involved in this underlying condition?
• Which physical finding is most characteristic of costochondritis?
• In systemic lupus erythematosus, which combination best describes typical serology?
• A 56-year-old woman with short bowel syndrome from mesenteric infarction has a diffuse maculopapular rash and hair loss. Which deficiency best explains her presentation?
• A 24-year-old woman at 38 weeks gestation in labor has a history of GBS infection during pregnancy. What is the appropriate intrapartum prophylaxis to prevent neonatal GBS infection?
• Hypomagnesemia causes hypocalcemia primarily by which mechanism?
• A 7-month-old boy with 4 days of fever, prolonged bleeding after circumcision, a history of eczema, thrush, and recurrent infections. This presentation is most consistent with which disorder?
• Newborn with bilateral clubfeet, no movement of the lower extremities at birth, and a palpable full bladder. What is the most likely diagnosis?
• Which cells secrete intrinsic factor?
• In a 32-year-old woman with two days of vomiting and RLQ tenderness with fever and leukocytosis; ultrasound shows no adnexal masses. Which diagnosis is most likely?
• A 37-year-old man with Duchenne muscular dystrophy wants to become DNR/DNI. His mental status is normal, and he expresses no ambivalence about the decision. What is the next step in patient-centered ethics?
• Which serologic test is most commonly used as an initial screen when evaluating for suspected systemic lupus erythematosus?
• A 27-year-old with molluscum contagiosum asks what test is needed next.
• Six hours after CABG, a patient develops hypotension, oliguria, reduced cardiac output, and a widened mediastinum on chest X-ray. What is the next step?
• To prevent acute kidney injury from hypovolemia in a febrile patient with poor oral intake who is undergoing angiography, what is the preventive measure?
• Disseminated Lyme disease is best treated with which therapy?
• A woman delivers a term baby. Fifteen minutes later, the uterus is enlarged and the fundus is 3 cm above the umbilicus with boggy consistency. Most likely diagnosis?
• CGD is caused by deficiency of which enzyme?
• In hyponatremia due to psychogenic polydipsia, which urine findings would support the diagnosis?
• A sexually active 24-year-old man presents with multiple painful penile sores and tender inguinal lymphadenopathy. What is the most likely diagnosis?
• In lymphoma, what does elevated LDH indicate?
• Radiation therapy is most appropriate in which scenario?
• Nonreactive PPD tests can occur in active TB infection due to dysfunction of which immune cells?
• A 57-year-old with nephrolithiasis, high serum calcium, low phosphate, and high PTH; CT shows renal calculi bilaterally. What is the cause of the calculi?
• Bartholin glands are located on which part of the vulva?
• In systemic lupus erythematosus, how many of the standard diagnostic criteria are typically required for diagnosis?
• A 67-year-old with calf pain on walking relieved by rest and diminished pedal pulses most likely has narrowing of which vessels?
• An 8-year-old boy presents with sudden facial swelling. This has occurred six times since birth, and family members are affected. Exam shows edema of the lips and tongue. Which serum study is abnormal?
• A 25-year-old with tremulousness and fatigue for 1 month. Pulse 120; thyroid gland is shrunken and non-tender; iodine uptake is decreased. What is the most likely diagnosis?
• Which organism is a Gram-negative diplococcus commonly associated with meningitis?
• A 37-year-old woman with progressive difficulty swallowing solids and liquids for 6 months has a barium swallow showing a bird’s beak and endoscopy with retained secretions but no mucosal lesions. Esophageal manometry will show which pattern?
• In a child with the classic presentation of erythema infectiosum (slapped-cheek rash), what is the treatment?
• Hereditary spherocytosis is suggested by which finding on a blood smear?
• A 3-year-old girl with drooling, rhinorrhea, bronchorrhea, and wheezing after exposure in a garage most likely has poisoning with what?
• A 6-month-old with diaper rash for 3 days has crusted, honey-colored lesions with clear discharge. What is the treatment?
• Three days after undergoing total hip replacement, a 50-year-old man becomes unable to move his legs and has urinary incontinence immediately after removal of an epidural catheter. He is on ketorolac, enoxaparin, and morphine. Diagnosis?
• A 72-year-old woman is hyponatremic 3 days after hospital admission for cerebral infarction. She has been receiving 5% dextrose in 0.45% saline since admission. Serum Na 120, osmolality 255. Urine Na 50, urine osmolality 358. Cause?
• At 39 weeks gestation with 6 cm dilation, 0 station, recurrent late decelerations and decreased variability, what is the next step?
• A 37-year-old woman with 1 year of irregular menses, visual field deficits in the outer fields, milky discharge from both breasts, MRI showing a pituitary microadenoma, and prolactin 40 ng/mL. Next step?
• A patient with severe facial trauma and a compromised airway who is unable to secure a mask seal requires what procedure?
• A firm rubbery supraclavicular lymph node is most suggestive of which diagnosis?
• A 6-year-old with four hours of scrotal pain, guarding, and right scrotal discoloration; left scrotum is normal. What is the next step?
• A 62-year-old with leukemia treated via subclavian catheter develops fever and gram-positive cocci in clusters; which drug is most appropriate?
• A 24-year-old with intermittent diplopia and drooping eyelids worse later in the day, difficulty chewing and swallowing, ptosis, and proximal weakness that improves with rest; DTRs normal. What is the diagnosis?
• Which ECG finding would be most supportive of an acute myocardial infarction in this patient?
• In a pregnant patient with recurrent genital herpes but no active lesions at term, which statement about delivery is most accurate?
• What is the mechanism by which ACE inhibitors lower blood pressure?
• In a patient with suspected meningitis and focal neurological signs, what is the next step before performing a lumbar puncture?
• A 62-year-old man has a 3-month history of progressive dysphagia to solids and liquids with regurgitation of undigested food and halitosis. The next best diagnostic test is?
• An otherwise healthy 37-year-old man with 3 months of back pain. NSAIDs help modestly; pain worsens with hyperextension; lateral XR shows slip of a vertebral body. Most likely diagnosis?
• A 55-year-old man with fever, neck pain, and fatigue for 2 weeks; weight loss; symptoms began after a URI. Temperature 100.9°F, pulse 110; thyroid is diffusely enlarged and tender; ESR elevated. Diagnosis?
• Chronic heavy alcohol use leading to cerebellar degeneration could be prevented by which measure?
• A 7-year-old with a history of aortic valve replacement is at greatest risk for bacterial endocarditis from which organism following dental manipulation?
• Which finding is most characteristic of a severe small bowel obstruction?
• A 27-year-old man faints after emotional distress while viewing his deceased brother's body. He reports sweating and lightheadedness and has not eaten in 14 hours. Which diagnosis is most likely?
• A healthy 9-year-old boy presents with months of low back pain that is worse in the morning and improves with activity, with limited flexion at the waist and tenderness over the sacroiliac joints. X-ray findings are consistent with bamboo spine. What is the most likely diagnosis?
• Lesions of the corticospinal tract producing Babinski signs and hyperreflexia indicate injury to which tract?
• A 42-year-old woman with fatigue, palpitations, weight loss, heat intolerance, and tremor has diffuse thyroid uptake with low TSH and high T4 and exophthalmos. What is the next appropriate pharmacologic therapy?
• Days after surgery, a patient develops leakage of serosanguineous fluid between incisions with minimal tenderness. What is the most likely diagnosis?
• A 37-year-old woman with sickle cell disease presents with 24 hours of fever, right upper quadrant pain after eating, nausea, scleral icterus, abdominal distension, decreased bowel sounds, and a positive Murphy sign. Ultrasound shows cholelithiasis with pericholecystic fluid and a normal common bile duct. What is the diagnosis?
• Acute stress disorder is diagnosed when symptoms occur within what time frame after a traumatic event?
• A 62-year-old man with sudden chest pain radiating to the back, unequal arm blood pressures, a diastolic decrescendo murmur, and a widened mediastinum on chest X-ray. Next step in management?
• A 27-year-old with high-grade squamous intraepithelial lesion; prior Pap smears normal; cervix and vagina exam show no gross abnormalities. What is the next appropriate step?
• Hyponatremia with preserved renal function in a patient who drinks excessive water is most likely due to which cause?
• If NSAIDs are contraindicated for an acute gout attack, which therapy is commonly used as second line?
• A 15-year-old with chronic corticosteroid use presents with two months of dull back pain and focal thoracolumbar tenderness. What is the most likely diagnosis?
• A 62-year-old woman with four days of severe back pain, weakness in both legs, tingling, and urinary incontinence; history of breast cancer treated with mastectomy 6 months ago. Babinski present. What is the next step?
• A 21-year-old with sudden pleuritic chest pain, fever, and a pleural rub without crackles most likely has which diagnosis?
• Which feature is most characteristic of physiologic nipple discharge?
• Pickwickian syndrome is another name for which condition?
• A third-trimester pregnant patient with severe abdominal pain and dark vaginal bleeding has an anterior placenta on ultrasound. What is the most likely diagnosis?
• A patient with proximal weakness and diplopia develops a mediastinal mass; the combination is most consistent with which diagnosis?
• A patient with severe pancreatitis develops hypoxemia with diffuse hazy bilateral infiltrates, cephalization of the pulmonary vasculature, and a normal pulmonary capillary wedge pressure. The most likely diagnosis is?
• In spondylolisthesis, which vertebral level is most commonly involved, with the upper vertebra slipping forward over the one below?
• A 14-year-old boy with sickle cell trait presents with a one-day history of severe pain in the left thigh and knee, unable to bear weight. XR of the knee is normal; hip ROM is limited by pain; WBC and ESR are normal. What is the next best step?
• After attending a church picnic, several people develop nausea and vomiting 3–4 hours after consuming egg salad. The most likely cause is?
• Where is vitamin B12 absorbed when intrinsic factor is present?
• Paget disease of the breast is most commonly associated with which type of underlying breast carcinoma?
• Which finding best supports the diagnosis of costochondritis in a patient with pleuritic chest pain and chest wall tenderness?
• A 57-year-old patient with multiple myeloma presents with fatigue, pallor, Hct 28%, a monoclonal spike, increased plasma cells, and lytic bone lesions. This patient is more susceptible to which organism?
• A 47-year-old patient with blunt chest trauma has a widened mediastinum and a C5 fracture. The life-threatening cardiovascular injury is most likely at which site?
• Which skin change is commonly seen with venous ulcers?
• A 28-year-old woman with PCOS desires pregnancy. The most appropriate pharmacologic therapy to induce ovulation is?
• Which lab finding would be most specific for high cell turnover in lymphoma?
• What is the standard initial management for a symptomatic Bartholin duct cyst?
• If the diagnostic cutoff for a test is decreased, what happens to sensitivity and specificity?
• A 27-year-old physician exposed to Hepatitis B–positive blood is vaccinated with adequate anti-HBs titers. What is the most appropriate management to prevent infection?
• Previously healthy 10-year-old girl with 2 days of itchy red rash on cheeks, arms, legs; fever, headache, malaise; symmetric, maculopapular, reticular, red, nonconfluent. Treatment?
• An 18-year-old at 37 weeks in labor with a history of genital herpes but no active lesions at present. What is the most appropriate delivery approach?
• In hereditary angioedema due to C1 esterase inhibitor deficiency, edema is primarily caused by increased levels of which mediator?
• Which finding differentiates central retinal vein occlusion from central retinal artery occlusion?
• A 37-year-old man with obesity (BMI 59) presents with shortness of breath and fatigue. ABG shows pH 7.32, PaCO2 56, PaO2 70 with a negative chest X-ray. What is the cause of the hypoxemia?
• Which fundoscopic finding is most commonly associated with embolic disease from carotid atherosclerosis?
• In blunt thoracic trauma with suspected thoracic aorta injury, which imaging modality is most definitive for diagnosis?
• An 17-year-old after a motor-vehicle collision presents with severe facial trauma and open fractures of the maxilla and mandible. He is combative and making gurgling sounds when he breathes. What is the most appropriate immediate airway management?
• Following a group A Streptococcus pharyngitis, acute rheumatic fever can cause which cardiac abnormality?
• What is typical of subacute thyroiditis after a viral URI?
• A 52-year-old woman with a 5-day history of continuous abdominal pain, nausea, and decreased appetite occurs 9 days after laparoscopic cholecystectomy for gallstones. She is febrile with jaundice; RUQ tenderness. Alkaline phosphatase and total bilirubin are elevated; ultrasound is negative. What is the next best step to evaluate her condition?
• What is the pathophysiology behind venous ulcers?
• A 72-year-old woman with 3 months of increasing abdominal girth, weight gain, poor appetite, ascites, and a fixed non-tender 8 cm ovarian mass on cul-de-sac exam. Next step?
• A 52-year-old man with an acute gout attack has not improved on celecoxib. Which therapy is most appropriate next?
• During a preparticipation sports exam, a healthy 14-year-old boy has a blood pressure of 150/90 with prior normal readings. What is the next step?
• A 25-year-old woman at 20 weeks gestation presents with severe epigastric pain radiating to the back and one episode of vomiting. The temperature is 100°F, blood pressure is normal, the fundus is non-tender, fetal heart rate is normal, hematocrit is normal, WBC is 9, and platelets are 220. What is the next step in evaluation?
• A 19-year-old man with agitation and nystagmus after possible drug use likely has intoxication with which substance?
• Which finding is most consistent with heat stroke?
• Which structure is involved in a varicocele?
• A 23-year-old man presents with acute onset auditory hallucinations and confusion one week after his wife was killed in a motor-vehicle collision. What is the most likely diagnosis?
• A 25-year-old primigravida at 27 weeks gestation has severe contractions for 6 hours; cervix is dilated 1 cm and 10% effaced; presenting part high. One hour later, contractions continue; cervix 1-2 cm dilated and 70% effaced, vertex at −2 station. GBS culture positive. What is the next best step to promote fetal lung maturity?
• A 4-year-old with tuberculosis has a nonreactive PPD test at 72 hours despite infection. This finding is best explained by which of the following?
• A 57-year-old with Factor XI and IgA deficiency receives blood and develops severe shortness of breath, urticaria, throat and tongue swelling, with hypotension. Diagnosis?
• What is the best initial measure to prevent acute nephrotoxic renal failure in rhabdomyolysis due to heat stroke?
• Which finding is NOT typical of Graves disease?
• Haemophilus influenzae is best described as which of the following by Gram stain?
• In a child with pancytopenia, what is the next diagnostic step to differentiate aplastic anemia from cancer?
• In rhabdomyolysis, which substance is typically detected in the urine and contributes to renal injury?
• A 32-year-old woman with a history of cervical insufficiency in labor at 28 weeks. Which drug should be given for neuroprotection?
• A 37-year-old man with chronic exposure to lead from renovating old houses presents with numbness in the hands and feet and weakness. Early treatment with which agent would have prevented progression of lead toxicity?
• One day after removal of a large meningioma, a patient becomes comatose. Lab results show Na 155, Cl 120, K 3.6, HCO3 24, BUN 16, creatinine 0.8, urine specific gravity 1.004. Over the past 24 hours she has received 2 L of normal saline and has urine output of 6 L. Which is the most likely explanation of the hypernatremia?
• Afebrile 32-year-old woman has cramping abdominal pain and watery stools for 4 days. Stool shows no neutrophils. The most likely cause is:
• A 77-year-old man with hemoptysis and recurrent pneumonia has radiographs showing thin-walled cystic spaces with air-fluid levels in the right lower lobe. What is the explanation?
• A 72-year-old man with exertional chest pain relieved by rest and not related to meals should undergo which test first to evaluate for coronary artery disease?
• Three days after open reduction and internal fixation of a right midshaft femoral fracture, a 63-year-old woman develops tenderness in the left calf. What test confirms deep venous thrombosis?
• An asymptomatic 60-year-old man two months after an upper GI bleed from a salicylate ulcer, with an incidental finding of a sliding hiatal hernia. Next step?
• Decreased radioactive iodine uptake is most consistent with which condition?
• A 57-year-old woman presents with hip pain and restricted range of motion. X-ray shows bone cysts and osteophytes; exam shows 20-degree hip flexion contracture. What is the most likely diagnosis?
• Pigment gallstones in patients with chronic hemolysis are primarily due to which process?
• In infectious mononucleosis due to EBV, which test is typically positive?
• Fat embolism syndrome typically presents with which arterial blood gas abnormality?
• Which type of clinical study is best suited to determine whether a new drug is more effective than placebo or standard therapy?
• A 51-year-old woman had 15 minutes of right-sided chest pain and shortness of breath after insertion of a right subclavian catheter for dialysis. X-ray shows a small apical pneumothorax; O2 94% on room air. Catheter is in good position. Next step?
• A 62-year-old woman is admitted for surgical resection of an ovarian tumor. Preoperative labs show BUN 80 and creatinine 5.7 with negative urine. Next step to determine the cause of renal failure?
• A child with recurrent abscesses since birth, S. aureus on culture; which cell type is primarily involved in this condition?
• Wiskott-Aldrich syndrome presents with which triad?
• A 21-year-old pregnant woman at 37 weeks presents with mild epigastric pain and a 24-hour history of moderate headache. Blood pressure is 150/98. DTRs are 3+, and urine protein is 3+. What is the next best step in management?
• A 70-year-old woman presents with peeling, scaling, and cracking of the right nipple. There is no mass on examination and mammography is negative. What is the most likely diagnosis?
• A 32-year-old patient presents with three months of burning substernal chest pain that worsens at night and a sour taste in the mouth, along with two months of a dry cough. What is the next best step in management?
• With a positive Borrelia IgM and signs of early Lyme disease, which antibiotic is appropriate to prevent long-term complications?
• In a patient with suspected amaurosis fugax due to carotid atherosclerosis, which vessel is the most likely source of the embolus?
• A 4-year-old presents after a sudden pulling on the arm; the child cannot use the left arm. The forearm is pronated and the elbow is slightly flexed. What is the appropriate reduction maneuver?
• In chronic granulomatous disease, infections are most commonly caused by which group of organisms?
• Bird-beak–shaped narrowing on a contrast study is classic for which disorder?
• In hereditary spherocytosis with a negative Coombs test and high reticulocyte count, which intervention would have prevented this condition?
• An alcoholic patient with significant weight loss and hypomagnesemia is most likely to have which electrolyte disturbance?
• Pernicious anemia is due to a lack of intrinsic factor caused by autoimmune destruction of which cells?
• Do kids born prematurely require a different vaccination schedule?
• A 32-year-old man with longstanding major depressive disorder reports persistent crawling sensations on the skin. He previously was treated for scabies and told he had shingles, but he now sees worms crawling out of his skin. Which substance is most likely detected on toxicology screening?
• Anoscopy visualizes which anatomical region?
• A patient presents with painful vulvar vesicles, fever, and tender inguinal adenopathy. How is herpes simplex virus diagnosed?
• A term pregnancy with a history of genital herpes but no active lesions presents at 37 weeks. Which delivery plan is most appropriate?
• Which study design assigns participants to treatment arms by chance to compare outcomes?
• Which triad is classically associated with cardiac tamponade?
• A 22-year-old after exposure to an unknown gas presents with vomiting/diarrhea, miosis, copious oral secretions, rhinorrhea, and fasciculations, and then seizures. What is the next step in treatment?
• Which finding would support a venous origin of a leg ulcer?
• Which exam finding is most indicative of an upper motor neuron lesion?
• On fundoscopic exam, the left eye shows dilated retinal veins with widespread hemorrhages and white patches; the right eye is normal. What is the diagnosis?
• Which combination is most characteristic of meningococcemia?
• A 6-week-old boy presents with the head rotated to the left and the chin deviated to the right. The head can be moved to the midline only with difficulty, and there is a 2 cm hard, non-tender oval mass on the right side of the neck. What is the most likely cause?
• A patient presents with a conjunctival hemorrhage shown on exam with no associated pain or vision changes. What is the next best step in management?
• A 27-year-old man with infertility presents with ill-defined soft masses high in the scrotum on both sides. What is the most likely underlying cause?
• Which statement is NOT part of the classic pentad of thrombotic thrombocytopenic purpura?
• A 3 cm non-tender fluctuant mass on the left posterior vulva is most consistent with which diagnosis?
• In hepatitis C with cryoglobulinemia, which therapy is classically used?
• A fainting episode preceded by emotional distress and accompanied by bradycardia is most consistent with which diagnosis?
• Why isn't it good to do a research study on patients in prison?
• A 16-year-old girl with severe abdominal pain for 2 days, multiple sexual partners in the past year, inconsistent condom use. Fever 100.9, pharyngeal erythema, tenderness in the right lower quadrant, cervical motion and left adnexal tenderness. WBC 12.5, ESR 30, UPT negative. Most likely diagnosis?
• A 72-year-old man with hypertension and coronary artery disease develops flash pulmonary edema. Which is the next best step in management?
• A patient who overdosed on heroin presents obtunded with a respiratory rate of 6 breaths per minute. The best initial treatment is?
• A 75-year-old man develops confusion and lethargy after being outdoors on a 100-degree day. He has fever 106.7°F, hypotension, hot/dry skin, decreased muscle tone, CK 8000, AST 400. What is the diagnosis?
• Zinc deficiency classically presents with acral or periorificial dermatitis, alopecia, and diarrhea. Which finding is also associated with zinc deficiency?
• Which agents are classically used to treat hepatitis C–associated cryoglobulinemia?
• In a 67-year-old man with a 5 cm anterior ankle ulcer, edema, warm feet, and weak pulses, what is the most likely diagnosis?
• In lead poisoning, which hematologic finding is typical?
• A 15-month-old girl presents with finger pain and swelling for months. She is well nourished with mild erythema over the cheeks. Labs show anemia, leukopenia, low C3, positive ANA, negative rheumatoid factor, and urine with blood and protein and 30–50 RBCs. What is the most likely diagnosis?
• Allergic bronchopulmonary aspergillosis is most likely in patients with which combination of findings?
• An 82-year-old patient with metastatic breast cancer is taking morphine syrup 5 mg every 4 hours for severe back and thigh pain. The analgesic effect wears off after about 2–3 hours. What is the next best step in pain management?
• A 24-year-old woman with amenorrhea for seven years due to anorexia nervosa is at increased risk for which complication compared with other women?
• Three weeks after emergency repair of an abdominal aortic aneurysm, a 72-year-old woman develops decreased cardiac index, decreased MAP, elevated PCWP, elevated CVP, and elevated pulmonary artery pressure with episodes of hypotension and arrhythmias despite IV dopamine. The most likely cause is?
• In catheter-related infection, which clinical finding supports catheter involvement?
• In differentiating ARDS from cardiogenic pulmonary edema, which finding most supports noncardiogenic edema?
• Clubbing of the digits in a patient with suspected lung cancer most strongly indicates which paraneoplastic process?
• Which symptom is characteristic of organophosphate poisoning due to cholinergic excess?
• Which clinical pattern most distinguishes cor pulmonale from left-sided heart failure?
• Which postpartum condition is the most common cause of postpartum hemorrhage?
• Guillain-Barré syndrome treatment includes which of the following as standard therapy?
• In congenital muscular torticollis due to sternomastoid contraction, what is the typical relationship between the chin and the affected muscle?
• A 26-year-old man with shortness of breath and tender nodules on the shins; chest X-ray shows bilateral hilar fullness. Which serum abnormality is likely present?
• Which drug is preferred for benign prostatic hyperplasia in a patient with orthostatic hypotension?
• Statin-associated myopathy is linked to decreased synthesis of which molecule involved in mitochondrial energy production?
• An 82-year-old woman being evaluated for possible Parkinson disease has word finding difficulty, mild upward gaze limitation, and brisk rotary nystagmus on left lateral gaze with intact MMSE. Which neurological finding would most warrant further evaluation?
• In lymphoma cases with splenomegaly, what does splenomegaly reflect?
• In organophosphate poisoning, seizures are best managed with which intervention?
• A 22-year-old with one month of insomnia, paranoia, suspected poisoning, social withdrawal, anxious mood, and auditory hallucinations; urine tox is negative. What is the next step in treatment?
• A newborn presents with severe anemia and hydrops fetalis due to incompatibility between maternal and fetal red cells. Which incompatibility is most likely?
• A 52-year-old woman with two weeks of progressive shortness of breath and exertional dyspnea; eight years ago diagnosed with breast cancer. Dullness to percussion in the right lower lung. Cause?
• In botulism caused by ingestion of preformed toxin, what is the pathophysiologic mechanism?
• Which organism is most commonly associated with ventilator-associated pneumonia and is a Gram-negative bacillus?
• A 27-year-old woman with Crohn disease on a steroid taper presents with five days of headache, abdominal pain, and vomiting; LMP is 7 weeks ago. She is dehydrated with abdominal distension and decreased bowel sounds. What is the most likely diagnosis?
• Management of phencyclidine (PCP) intoxication presenting with agitation and nystagmus is best with which medication class?
• A 72-year-old man on a statin presents with progressive proximal muscle weakness and tenderness of the thighs and arms, with normal deep tendon reflexes. Where is the site of the abnormality?
• In the newborn of a mother with prior varicella immunity, what is the mechanism that provides protection to the infant?
• A 32-year-old man experiences exertional syncope and has a systolic murmur at the left sternal border that changes with maneuvers; most likely diagnosis?
• A patient with nephrolithiasis experiences pain relief in the ED after morphine; what is the appropriate next step given imaging suggests stones will pass spontaneously?
• In a patient with type 2 diabetes and early nephropathy, starting which medication helps prevent progression of nephropathy?
• An asymptomatic 27-year-old woman with HIV requests immunizations. She has prior MMR, tetanus last given 6 years ago, Hepatitis B antibodies are positive, and CD4 count is 450. Which vaccine should she receive?
• A 37-year-old man with ascending weakness after a URI, absent deep tendon reflexes, hypotonia, and mild sensory loss. What is the diagnosis?
• Six hours after undergoing left thoracotomy for coarctation repair, a 10-day-old neonate is irritable while sedated and ventilated. Pulse is elevated; respirations 30. What is the most appropriate next step?
• A patient with multiple sclerosis begins ACTH therapy and soon develops bizarre, paranoid behavior. What is the most appropriate next step in management?
• A 68-year-old with chest pain and ST elevations in V2-V6; CK is normal. Diagnosis is?
• A 72-year-old patient with cholecystitis develops renal failure. Urinalysis shows 1+ blood, 1+ protein, and pigmented granular casts with renal tubular epithelial cells. What is the most likely diagnosis?
• Which ECG finding is most characteristic of a significant pericardial effusion with tamponade?
• An asymptomatic 23-year-old man has a positive PPD (>15 mm), with no prior testing, negative chest X-ray, and negative sputum. What is the next step?
• A patient with three days of fever and left-sided chest pain has a Gram stain showing small Gram-negative bacilli. Which organism is the most likely cause of pneumonia?
• A 42-year-old presents with unilateral vision loss, an afferent pupillary defect, and pallor of the optic disc. Which diagnosis is most likely?
• A 20-year-old with one year of auditory hallucinations and bizarre behavior; labs are normal; hyperreflexia and mild resting tremor; Utox is negative. What is the most likely diagnosis?
• Meigs syndrome is classically defined by a triad of which findings?
• Which symptom is most characteristic of alcoholic cerebellar degeneration?
• Which intervention best reduces the risk of ovarian cancer by suppressing ovulation?
• In a trauma patient with a right hemopneumothorax and pelvic fracture, who remains hypotensive after rapid fluid resuscitation, what is the next best step?
• A 19-year-old African American man has 9 months of 6–12 hour episodes of intermittent watery diarrhea with abdominal cramps and bloating. He reports postprandial diarrhea since age 12, worse since college. What is the most likely etiology?
• In a patient with a firm, rubbery supraclavicular lymph node and splenomegaly, which laboratory finding is most likely?
• In cardiogenic shock, which combination of hemodynamic findings is typically observed?
• Cutaneous larva migrans is most commonly caused by infection with which organism?
• Which radiographic findings are commonly seen in allergic bronchopulmonary aspergillosis?
• A 40-year-old woman has a few drops of yellow discharge from the left nipple. Fluid can be expressed when the nipple is squeezed; there is no spontaneous discharge and no breast mass on exam. Mammography is negative. What is the most likely diagnosis?
• A 42-year-old man with alcohol-induced pancreatitis presents four days after a binge with hypotension (90/50) and cool, clammy skin. ECG shows sinus tachycardia. What is the most likely cause of these abnormal vital signs?
• In an elderly patient with cognitive impairment and signs suggesting hypothyroidism, which two physical findings most strongly support hypothyroidism?
• An 11-year-old presents with body odor and a 3-month history of argumentative behavior and secrecy. Exam shows Tanner stage 2 and mild facial acne. The next step is to:
• In hereditary angioedema due to C1 esterase inhibitor deficiency, which complement component is typically reduced?
• A 50-year-old woman with a 5-year history of metastatic breast cancer develops sudden shortness of breath with hypotension, jugular venous distension, and distant heart sounds; ABG shows respiratory alkalosis with hypoxemia; CXR shows cardiomegaly; ECG shows electrical alternans. What is the next best step?
• A 72-year-old man with a history of DVT and PE presents with six weeks of dyspnea. Exam shows JVD, ascites, and pitting edema of the legs. Chest X-ray shows mild cardiomegaly without pulmonary edema. What is the most likely diagnosis?
• A 4-year-old with three days of fever and cough; rhinorrhea; warm pink skin; lungs are clear. What is the most likely diagnosis?
• In congenital muscular torticollis due to contraction of the sternomastoid muscle, which description best matches the head position?
• In a clinical study of hip fracture outcomes, investigators adjusted for age and gender only. Which issue raises concern about the validity of the results?
• During anoscopy, a 62-year-old is found to have adenocarcinoma on the anal verge. What is the next best step in evaluation?
• A 16-year-old girl seeking contraception presents with familial conflict; what psychosocial intervention is most appropriate?
• A 15-year-old boy presents with several months of depressed mood, insomnia, a 10-pound weight loss, deteriorating academic performance, and a flat affect. What is the most likely diagnosis?
• A 42-year-old woman presents with intermittent small-volume urinary leakage that occurs only after voiding. A 3 cm midline, cystic, tender vaginal mass is observed in the midline third of the vagina. Urinalysis is normal, and postvoid residual volume is 50 mL. What is the most likely diagnosis?
• Which serologic test is most helpful in supporting a recent group A Streptococcus infection following pharyngitis?
• A patient presents with nausea, vomiting, diarrhea, abdominal pain, blurred vision, dry mouth, and numbness after attending a party where she ate pork, shrimp, rice, and home-canned preserves. Pupils are dilated and sluggish, mucous membranes dry, and weakness is 4/5 in the lower extremities. What is the most likely cause?
• Which is the most likely diagnosis in a 17-year-old with four days of severe odynophagia after taking pills for plantar fasciitis?
• An elderly man, 77, has progressive forgetfulness over two years. The liver is palpable; there is 2+ nonpitting edema, diminished reflexes, slow gait, and a MMSE of 20/30. Serum alkaline phosphatase and AST are elevated. What is the most appropriate next step?
• Which symptom is most characteristic of a urethral diverticulum presenting as a vaginal cystic mass and post-void dribbling?
• Where is a thymoma most likely located?
• A 22-year-old primigravid woman at term has a history of three UTIs earlier in pregnancy; the last infection occurred at 22 weeks. What is the most likely cause of the recurrent UTIs?
• A patient 2 hours after emergency repair of a perforated gastric ulcer, on digoxin and diuretic therapy, develops multifocal premature ventricular contractions. Which electrolyte abnormality is most likely present?
• Primary lactase deficiency is most common in individuals of which descent?
• What is the initial management for congenital muscular torticollis?
• Which imaging finding is characteristic of bronchiectasis and reflects its underlying pathology?
• An 82-year-old patient with congestive heart failure whose creatinine rises. What explains the worsening renal function?
• Five days after open splenectomy for ITP, a patient develops sudden shortness of breath with decreased breath sounds at the left base and leukocytosis. What is the next best step?