NBME CBSE REAL EXAM 258 A+ QUESTIONS AND ANSWERS LATEST 2023-2024 (usmle step 3)MEDICAL EXAMINATION
Disease associated with hypothyroidism correct
... [Show More] answers hyperlipidemia (usually just elevated LDL, but sometimes also elevated triglycerides)
Good source of calcium in lactose-intolerant pt.s correct answers yogurt with live activated cultures (contains beta-galactosidase, which is tolerated by lactose-intolerant ppl)
PML correct answers -immunocompromised pt.s (AIDS)
-most common symptoms are hemiparesis, disturbance in speech, vision, gait, sometimes CN deficits
-MRI shows multiple dmyelinating, non-enhancing lesions with NO mass effects
-tx is initiation or optimization of HAART
-can have similar MRI findings with HIV encephalopathy but usually will be symmetric and pt will present with dementia
Ring-enhancing lesion with mass effect on MRI correct answers -toxoplasmosis
-CNS lymphoma
-brain abscess
Post-partum hemorrhage management correct answers 1. pelvic exam to look for retained placental fragments
2. bimanual uterine massage to induce contractions
3. uterotonic drugs (IV oxytocin)
4. uterine artery ligation
Ramsay Hunt syndrome correct answers -herpes zoster oticus
-traid of:
1. ear pain
2. vesicles in external auditory canal
3. ipsilateral facial paralysis
-tx with IV acyclovir
Bad complication of acute otitis media correct answers mastoiditis
Malignant otitis externa correct answers -invasive infection of the external auditory canal and the bones forming the base of the skull
-presents with:
1. marked ear pain
2. purulent drainage from ear
3. granulation tissue at the floor of the bone-cartilage junction in the external auditory canal (pathognomonic)
-TM usually intact
-often caused by Pseudomonas
-seen in DM pt.s and after aural irrigation
-tx with IV abx, then oral for 6-8 weeks; can use piperacillin, ticarcillin, FQs, 3d gen cephalosporins (ie. anti-pseudomonal abx)
Constitutional pubertal delay correct answers -delayed puberty with:
-bone age less than chronological age
-positive family history
-no evidence of systemic disorder
Kallman's syndrome correct answers -anosmia
-hypogonadotropic hypogonadism
-sometimes midline facial defects
Klinefelter's syndrome correct answers -47XXY
-normal puberty
-hypogonadism with atrophy of Leydig cells
-small, firm testes
Evidence of sideroblastic anemia on bone marrow bx correct answers ringed sideroblasts when stained with Prussian blue (RBC precursors with pigmented rings around the cell nucleus)
Iron studies in sideroblastic anemia correct answers -serum iron and ferritin INCREASED
-TIBC and transferrin saturation NL or increased
Causes of sideroblastic anemia correct answers 1. congenital
2. idiopathic
3. myelodysplastic syndrome
4 drugs (isoniazid, chloramphenicol, linezolid)
5. toxins (EtOH, zinc, lead)
6. nutrional deficiency (copper, pyridoxine)
7. hypothermia
Treatment of lead poisoning correct answers EDTA chelation
Iron studies in iron deficiency correct answers -serum iron LOW
-% saturation LOW
-transferrin HIGH
-TIBC HIGH
-ferritin LOW
-soluble transferrin receptor HIGH
Iron studies in anemia of chronic disease correct answers -serum iron LOW
-% saturation LOW
-transferrin LOW
-TIBC LOW
-ferritin NL or INCREASED
-soluble transferrin receptor NL
Hypoproliferative normocytic anemias (7) correct answers TRAM MAP
1. thyroid disease (can also be macrocytic)
2. renal failure
3. aplastic anemia
4. multiple myeloma
5. myelofibrosis
6. anemia of chronic disease
7. pure red cell aplasia
Most common form of CONGENITAL aplastic anemia correct answers Fanconi's anemia
(aplastic anemia, short stature, cafe au lait spots, genitourinary abnormalities, microphthalmia, mental retardation, skeletal abnormalities)
Causes of ACQUIRED aplastic anemia correct answers 1. drugs (chloramphenicol, chemo agents, gold, indomethacin, diclofenac, phenylbutazone, sulfonamides)
2. toxins (benzene, glue vapors)
3. infections (parvo B19, EBV, CMV, HIV, non a/b/c hepatitis)
4. malignancy (hairy cell leukemia, ALL, AML, MDS)
5. other (paroxysmal nocturnal hemoglobinuria, connective tissue disorders)
NOTE: most of the same stuff causes pure red cell aplasia
Multiple myeloma correct answers 1. monoclonal protein is present in serum or urine (M protein)
2. clonal plasma cells present in bone marrow
3. evidence of related organ or tissue impairment (ie. hypercalcemia, renal insufficiency, anemia, bone lesions/fx)
Bone marrow finding with multiple myeloma correct answers Rouleaux formation of red cells (like stacks of coins) [Show Less]