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NBME Medicine Form 6 - Answers & Explanations

Updated: Mar 22, 2020

Author: Sagie Haziza & Gennadiy Guralnik

Editor: Jordan Abrams

1) Abnormal red blood cell membrane

• Hereditary spherocytosis: jaundice, anemia, high-normal MHCH, loss of central pallor

• ⊖ Direct Coombs rules out AIHA

• Cholecystectomy → chronic hemolysis → indirect bilirubin gallstones

2) Positive findings for anti-centromere antibody

• CREST syndrome: calcinosis cutis, Raynaud phenomenon, esophageal dysmotility,

sclerodactyly, telangiectasia

3) Syringomyelia

• Cystic cavity in spinal cord → block of anterior white commissure (spinothalamic tract) →

bilateral, cape-like loss of pain and temperature

• Fine touch sensation preserved

• Associated with Chiari 1 malformation

4) Ruptured papillary muscle

• Acute, usually within 3-5 days post MI

• Typically with RCA infarction (posteromedial papillary muscle)

• Clinical findings: Severe pulmonary edema, new holosystolic murmur

5) No further testing is indicated

• Normal BP (140/90)

• Hematocrit normal (42%)

• No RBC in urinalysis

• HR ↑ because of pain/SNS

6) Ambulatory ECG monitoring

• Indications: syncope, near syncope or dizziness occurring on a near daily basis

○ Palpitations

○ Afib for assessment of rate or rhythm control

○ Ectopic or premature atrial beats

7) Severity of hypoxemia

• COPD → ↑ shunting → ↑ hypoxic vasoconstriction → pulmonary hypertension (loud S2/P2,

prominent pulmonary arteries, JVD)

8) No further tests are indicated

• Preoperative cardiac assessment includes: ECG, echo and stress test

• Stress test is only indicated when the patient has poor functional capacity: breathless or

chest pain with activity

9) Jarisch-Herxheimer reaction

• Treatment for syphilis (or other spirochetes [eg, lyme disease, leptospirosis]) → toxin release from killed bacteria

• Clinical findings: acute onset fever, chills, myalgia

10) Metformin

• Diabetic patients with comorbid pneumonia have ↑ risk of lactic acidosis if taking


• Metformin is also contraindicated in patients with liver failure, renal failure or sepsis

11) Surgical excision of apocrine tissue

• Occlusion of follicular pilosebaceous unit → Hidradenitis suppurativa

• Commonly affects intertriginous skin areas (eg, axilla, groin)

• Treatment is early radical excision of affected area

12) Hydration

• Preventative measures for contrast induced kidney injury: peri-procedural saline

hydration, use lowest volume of contrast agent, hold NSAIDs

13) Acyclovir

• Acute (<1 week) fever, altered mental status, or focal neurological symptoms are consistent

with HSV meningitis

• Treatment: Acyclovir

14) Airway compromise

• Tonsillitis with massive edema may occlude airway

15) Intravenous administration of 0.9% saline

• Treatment for suspected variceal hemorrhage: place 2 large bore IV (volume resuscitation),

IV octreotide, Abx → Endoscopic therapy

16) 80%

• 80 positive infections on new stool test

• 100 positive infections on gold standard biopsy

• Sensitivity = 80/100

17) Washing the area of involvement

• After a needle stick injury, a patient with immunization to Hep B does not need vaccine/booster, but should sterilize the area

18) Inflammation caused by release of cytokine by effector and memory T lymphocytes

• Type 4 delayed hypersensitivity

19) Corticosteroids therapy

• ↓ platelets <30,000 or symptoms of ITP → treat with corticosteroids, IVIG or splenectomy if refractory

• Megakaryocytes seen on bone marrow aspiration

20) Chlamydia trachomatis

• Tender boggy prostate, WBCs on urinalysis, ⊖ culture in young patient

• Intracellular indicates chlamydia (vs. gonorrhea)

21) Ulnar nerve compression

• Ulnar nerve (C8-T1) insult → hypothenar atrophy + interosseous muscle

dysfunction (ab/adduction of fingers [paper slipping from fingers])

22) Swallowing study

• Oropharyngeal dysphagia clinical presentation: Chronic cough after meals, mild dysarthria,

history of multi infarct dementia

• Dx: video fluoroscopic barium swallow

23) Iron

• Anemia with hypochromasia (central pallor) is consistent with iron deficiency anemia

• Not sideroblastic (no basophilic stippling seen)

• Not megaloblastic (no hyper-segmented neutrophils)

24) Serum protein electrophoresis

• Multiple myeloma: hypercalcemia, renal failure, anemia, bone lytic lesions

25) Subcutaneous administration of enoxaparin

• Evidence of DVT on ultrasound→ enoxaparin is the next best step

• Warfarin takes several days to work and is not the best treatment

26) Lisinopril

• ACEi → ↓ mortality in HFrEF (heart failure with reduced ejection fraction)

• Metoprolol and spironolactone would not work well in an acute setting because they could

↓ cardiac output (CO)

27) Administration of calcium gluconate IV

• Parathyroid gland removal post surgery → tetany, cramps, seizures

• Treatment of hypocalcemia: calcium gluconate/chloride

28) Rhabdomyolysis

• Barbiturates → immobility → ↑ CK, ↑ phosphate → AKI → blood detected on urine

dipstick, but absent on microscopy = rhabdomyolysis

29) Anaerobic empyema

• Right lower lobe infiltrate + foul smelling fluid indicates aspiration (likely anaerobes)

30) Begin lisinopril therapy

• ACEi use in a patient with diabetes & hypertension → ↓ mortality

• ACEi → ↓ diabetic nephropathy progression

31) Alveolar destruction and fibrosis

• FEV1/FVC ratio < 0.7 = Obstructive disease

• Emphysema → alveolar destruction (↓ DLCO) → ↓ breath sounds

32) Full thickness biopsy

• Possible malignancy: size > 6mm, asymmetry, multiple color

• Biopsy and excision if diagnosis confirmed

33) Serum calcium concentration

• Ranson Criteria for pancreatitis

○ WBC > 16K

○ Age > 55

○ Glucose >200 mg/dL

○ AST > 250

○ LDH > 350

34) Oral ibuprofen

• Diffuse ST elevation/PR depression, pleuritic chest pain relieved while sitting up, friction

rub are consistent with pericarditis

• Treatment = ibuprofen (1st line), colchicine and glucocorticoids (2nd line)

35) Allergic bronchopulmonary aspergillosis

• Hypersensitivity response to Aspergillus growing in lung mucus

• Associated with asthma

36) Urine free cortisol concentration in a 24 hour specimen

• Weight gain, hirsutism, truncal obesity, striae, irregular menses, acne are consistent with

37) Prepatellar septic bursitis

• Unaffected Range of motion = extra-articular

• Red, swollen area overlying patella + fever = bursitis complicated with infection

38) Insufficient inhibition of neutrophil elastase

• Obstructive lung X-ray, spirometry in young patient, andfather’s early diagnosis of

emphysema is consistent with a1 antitrypsin deficiency

39) ↓ K+, ↓ Cl-, ↑ pH

• Vomit → GI loss of HCL, production of HCO3- → RAAS activation from hypovolemia → Loss of K+, reabsorption of HCO3-

40) Avascular necrosis

• Steroid treatment of Vasculitis predisposes to avascular necrosis

• Crescent sign on MRI

41) Acute tubular necrosis

• ↓ urine output

• Granular casts

42) Pap smear + PCP prophylaxis

• PCP prophylaxis with TMP-SMX in CD4+ <200, thrush or history of PCP

• Pap smear CD4+ <500

43) Switch from glyburide and metformin to intermediate acting insulin

• Creatinine is elevated after initial treatment. Lactic acidosis from metformin → muscle pain,

nausea, SOB

• HBA1C + glucose is still elevated after metformin trial à switch to insulin

44) Adverse effect of verapamil

• Constipation

• Diabetic patient without neuropathy is unlikely to have neuropathy of colon

45) Subclavian steal syndrome

• Stenosis/occlusion of the proximal subclavian artery → reversal of blood flow in the

ipsilateral vertebral artery → upper extremity ischemia (pain, fatigue, paresthesias) and/or

vertebrobasilar insufficiency (dizziness, ataxia, disequilibrium)

46) Prerenal azotemia

• BUN/CR ratio >20:1, urine sodium <20 after diarrhea

47) Renal biopsy

• History of IVDU (IV drug abuse), Hepatitis, blood 3+, protein 4+, presence of dysmorphic

RBC = membranoproliferative glomerulonephritis

• Biopsy for DX

48) Cigarette smoking

• Greatest increased risk for MI

49) Recurrence of breast cancer

• Hypercalcemia of malignancy >14 (greater than primary hyperparathyroidism [12-14])

• Breast, gynecological, squamous cell, renal cell carcinoma → PTHrP secretion

• Metastasis → Breast, multiple myeloma, lymphoma

• ↑ 1,25 OH Vitamin D: lymphoma

50) Weight loss

• ↑↑ BMI is the number one cause of osteoarthritis

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Dr David Olasupo
Dr David Olasupo
Nov 01, 2021

This is absolutely amazing ,high yeild and time saving.

How can i access CMS answers for 3-6 for Med, surg, Obs/Gynae, Paed,Psychaitry.

Just came across this "live-saver" my exams is just 5weeks away


these are seriously AWESOME. so much time saved when reviewing and all very accurate. many thanks to you guys. was wondering if you will ever do the neuro CMS answers 3 - 6?


Jordan Abrams
Jordan Abrams
Apr 27, 2020

@sonya The HY Medicine does not provide any exam questions. You can purchase the exams through NBMEs webpage.


Sonya Bhatti
Sonya Bhatti
Apr 26, 2020

Do you have a site where I can get these exams offline?


Tapan Thaker
Tapan Thaker
Mar 20, 2020

Thank you so much.

If you could upload Surgery , Pedia, Obgyn CMS 5,6 it would be really helpfull.

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