Jordan AbramsNBME Medicine Form 3 - Answers & Explanations
Updated: Feb 25, 2020
1) Vitamin B1 (thiamine) • Wernicke encephalopathy triad: ataxia, ophthalmoplegia, confusion
• Thiamine before glucose
2) Osteosarcoma • Associated with Rb mutation • Periosteal bone reaction - codman triangle
3) Pertussis • Paroxysms of intense cough with posttussive vomiting
4) Enterotoxigenic Escherichia coli
• Travelers diarrhea = ETEC
5) Admit the patient to the hospital
• Stable angina has progressed to unstable angina → admit to hospital (cath lab)
6) Chest tube placement • Complicated parapneumonic effusion ( pH < 7.2, glucose < 60) • Treat with chest tube placement to drain the pus and IV antibiotic
7) Medial degeneration of the aorta • Cystic medial degeneration predisposes to dissection
8) Test for factor VIII inhibitor • During a mixing study, normal plasma is added to plasma from a hemophiliac patient
• Clotting deficiencies should correct (PTT returns to normal)
• Factor inhibitors will not correct (PTT will fail to normalize if factor VIII inhibitor is present)
9) Exercise stress echocardiography • This patient already has an abnormal EKG (LBBB will make EKG difficult to interpret)
• Stress echo should be performed instead (which will likely show areas of hypoperfusion induced by exercise)
10) Bromocriptine therapy • Dopamine agonists inhibit prolactin secretion
11) Impaired DNA synthesis • Megaloblastic anemia (impaired DNA synthesis d/t lack of B9 or B12)
12) Anaphylactic shock • Likely due to a food allergy at the restaurant
• Diffuse bronchospasm, hypotension, tachypnea, tachycardia = shock
13) Pericarditis • Lupus is associated with serositis (eg, pericarditis) • Pain in pericarditis is worsened with inspiration (pleuritic) and relieved by leaning forward
14) Labyrinthitis • Acute onset of vertigo with nausea, vomiting and gait disturbance
• Distortion of light reflex off tympanic membrane due to ear fullness
15) Sclerosing cholangitis • PSC is associated with Ulcerative Colitis
• Direct hyperbilirubinemia
16) Chronic hepatitis C • Blood products weren’t screened for HCV until 1992 • HCV is more likely to become a chronic infection (~75%); HBV rarely develops into a chronic infection (~5%)
17) Lung abscess • Cavitary lesion with air fluid level suggests abscess
• Alcoholics → ↑ risk of aspiration pneumonia
18) Serum insulin-like growth factor 1 • IGF-1 mediates most effects of GH - preferred initial test for Acromegaly
• GH levels have wide fluctuations and are not sensitive
19) Ceftriaxone • Numerous gram-positive diplococci = strep pneumo
• Treat with 3rd generation cephalosporin
20) Infection of the joint secondary to disseminated Neisseria gonorrhoeae
• Purulent mono arthritis and/or triad of polyarthralgias, tenosynovitis, and vesiculopustular skin rash
21) Mild cognitive impairment
• MMSE < 24 is suggestive of dementia or delirium
• This patient is able to live independently (drive alone without getting lost, manage his finance) - this with old age is suggestive of mild cognitive impairment
22) Nephrotic syndrome • Decreased protein and edema are consistent with nephrotic syndrome
• Patient is previously health - unlikely that cirrhosis or malnutrition manifests within a 2 week period
23) Myocardial infarction • EKG is consistent with STEMI • Tamponade EKG shows low-voltage QRS with electrical alternans
24) Type 2 diabetes mellitus • HTN + BMI of 32 → ↑ risk of diabetes
25) Administration of warfarin • DVT prophylaxis with LMWH/Heparin (second line option is warfarin)
26) Primary metabolic acidosis • Cardiogenic shock → hypoperfusion → hypoxemia → ↓ oxidative phosphorylation → lactic acidosis → metabolic acidosis
27) Colonoscopy • Patient FOBT in patients > 50 → colonoscopy; >40 → sigmoidoscopy; <40 → anoscopy