NBME FORM 4

SECTION 1

SECTION 2

NBME FORM 4

NBME FORM 4

SECTION 3

SECTION 4

NBME FORM 4

i think this answer key is 96-98% correct!

Block 1

1. D 2. A 3. E 4. A 5. D 6. B 7. E 8. C 9. D 10. D 11. E12. A 13. E 14. B 15. D 16. B 17. F 18. b19. A 20. E 21. B 22. D

23. G24. B 25. D 26. A 27. F 28. G 29. C 30. A 31. B 32. D 33. D 34. A 35. A 36. F 37. D38. A 39. A 40. A 41. D42. A 43. D 44. C 45. B 46. E

Block 2

1. E 2. C 3. G 4. B 5. C 6. E 7. C 8. D 9. B 10. B 11. D 12. B 13. A 14. C 15. A 16. C 17. M 18. C 19. B 20. E21. A 22. C 23. D 24. E 25. B26. C 27. A

28. C 29. B 30. e (reference: http://www.ncbi.nlm.nih.gov/pubmed/19639421 )31. A 32. E 33. C 34. B 35. D 36. E 37. C 38. A39. D 40. B 41. D 42. I 43. B 44. A 45. E 46. e (reference: http://emedicine.medscape.com/article/760563-treatment )

Block 3

1.B 2. E 3. C 4. E 5. B 6. D 7. A 8. B 9. B 10. A 11. D 12. C 13. B 14. B 15. E 16. A 17. D 18. B 19. B 20. Q 21. H 22. E 23. J 24. E 25. C 26. B 27. A 28. B 29. E 30. A 31. D 32. E

33. C 34. A 35. A 36. E 37. D 38. A 39. A 40. d 41. C 42. G 43. C 44. C 45. F 46. B

Block 4

1d 2e 3d 4d 5c 6A (reference: http://emedicine.medscape.com/article/292759-overview#a11 )7c 8e 9c 10 E11b 12d13c 14d 15c 16e 17c 18c 19A 20E 21a 22a 23a 24e 25b 26g 27f 28b 29B30e 31b 32e 33b 34d 35c36f 37a

38g 39f 40e 41a 42d 43b 44g 45c 46b

good luck and wish you all the best!

Step 2 CK NBME Form 4

Edited

Block 1

1. D (recurrent candidal infections >> impaired cell mediated

immunity)

2. A (reassuring pattern)

3. E (normal pressure hydrocephalus >> impairment of the higher

mental control of the bladder which basically inhibits the voiding

reflex)

4. A (post-streptococcal acute glomerulonephritis)

5. D (hostility towards authority without gross moral violations)

6. B (high BP plus papilledema)

7. E (Multiple sclerosis)

8. C (the patient is psychotic so her demand for an abortion

cannot be allowed. Haloperidol can be used in pregnancy if the

benefit to the mother clearly outweighs the potential fetal risk

9. D (Crohn's disease predisposes to fibrotic strictures)

10. D (Slipped capital femoral epiphysis)

11. E (RSV infection)

12. A (facial edema + linked with history of food intake)

13. E (hint: irregular mobile mass in the right upper quadrant)

14. B (blood cultures to confirm endocarditis. Blood cultures

should always be collected before antibiotic treatment begins.)

15. D (chronic pancreatitis. amylase and lipase may or may not be

elevated. pancreatic enzyme replacement therapy to relieve

steatorrhea.)

16. B (increased intracranial pressure plus growth retardation plus

visual difficulty >> craniopharyngioma fits)

17. F (joint aspiration >> first step in management of a swollen,

tender joint)

18. D NSAIDS (Osgood – Schlatter Disease: Osteochondrosis of the

tibial tubercle Tx: Kaplan notes say immobilization of the knee in

an extension (or ) Cylinder cast for 4 – 6 weeks. Books also

mention NSAIDs as part of treatment. Apparently the correct

answer on online NBME, informed by a commenter, is D - NSAIDs)

19. A (pulmonary embolism, Spiral CT scan preferred over

pulmonary angiography)

20. E (restrictive pattern on PFTs)

21. B (Intussception >> contrast enema is diagnostic and

therapeutic)

22. D (oral-esophageal candidiasis in HIV >> Fluconazole)

23. G (Diabetes mellitus)

24. B (Febrile neutropenia)

25. D

26. A (only 40% of original participants remain)

27. F (patient was well-controlled on Paroxetine >> best option is

to resume it)

28. G (hint: masses vary in size with her menstrual cycle)

29. C

30. A ( diastolic decrescendo murmur ) A

31. B (Systolic murmur radiating to carotids is classic for aortic

stenosis.)

32. D (Metronidazole for pseudomembranous colitis)

33. D

34. A (L to R shunt >> increased pulmonary blood flow)

35. A (subarachnoid haemorrhage can lead to diabetes insipidus)

36. F (vitamin D supplementation is recommended for all

breastfed infants)

37. D (patient fulfills criteria of Major Depression. Note the

marked anhedonia >> no longer enjoys the taste of food)

38. A (von Willibrand disease)

39. A (specific trigger, doesn't fulfill criteria of Major Depression)

40. A (Urge incontinence)

41. D (N0 M0 indicates that the tumor removal was most likely

complete, therefore metastatic diseases is unlikely. Plus patient's

smoking history also is risk factor for primary lung cancer.)

42. A (Hemochromatosis)

43. D

44. C (alzeimer’s Dementia)

45. B (Postal worker >> high risk for bioterrorism. Cutaneous

anthrax eschar is characteristic)

46. E (ankle edema >> well known side effect of Nifedipine)

Block 2

1. E (positive ANA and dsDNA)

2. C (ST elevation on ECG at lead 2 3 AvF)

3. G (Tension pneumothorax)

4. B handwashing practices. B

5. C (Naproxen >> nephrotoxicity)

6. E

7. C (looks like alcohol withdrawal)

8. D (Hydatidiform mole)

9. B (obesity, papilledema, bifrontal headaches)

10. B (hyperkalemia with ECG changes >> Ca Gluconate)

11. D (GI obstruction, first step NG decompression)

12. B (depression history + mania episode now) B

13. A

14. A (2 year h/o productive cough >> Chronic Bronchitis. O2 sat:

90% >> Blue Bloater)

15. A (smoking is a contraindication for OCPs)

16. C (Foreign body ingestion >> bronchoscopy)

17. M low TSH high blood pressure M

18. C (Isoniazid neurotoxicity preventable by administration of B6)

19. B (hyperglycemia can cause hyponatremia)

20. E (elderly patient, hematocrit too low, transfuse RBC. We

don't use 5% Dextrose water or 0.45% saline for resuscitation, we

use 0.9% Saline, which isn't given among options)

21. A (oral & genital ulcers plus erythema nodosum)

22. C (Erysipelas)

23. D (MRI shows a mass obstructing CSF outflow from the

ventricles. Choice E is wrong. Choroid plexus papilloma most

commonly occurs in Children, and even Choroid plexus papilloma

itself can cause obstruction to CSF flow depending on its location)

24. E (cystic fibrosis)

25. B (Endometriosis. Clues >> infertility, dysparunea)

26. C

27. A skin hyperpigmentation A

28. C (typical position of venous ulcers + skin discolouration

(lipodermatosclerosis) plus there r varicose vein near the knees if

u look closely)

29. B (NSAID induced (pseudo)allergic reaction. Avoid aspirin)

30. C (best option)

31. A (peripheral arterial disease makes atherosclerotic process

most likely)

32. E (essential tremor >> propranolol)

33. C (poorly controlled HTN >> increased risk of MI)

34. B (CA of head of pancreas)

35. D (most common agent of septic arthritis>> staph aureus) D

36.E (mitotic figures means high proliferation, plus infiltrating into

surrounding muscle) E

37. C (long-standing lymphedema >> lymphangiosarcoma)

38. A (avoid permanent/prolonged catheterization wherever

possible)

39.D (shallow respiration, ) D

40. B (Nursemaid's elbow, radial head subluxation. treatment is

gentle supination and flexion)

41.D…( heptic amboebiasis) D

42.I (travel history plus fever and splenomegaly> suspect malaria)

I

43. B

44. A (diffuse enlarged uterus >> adenomyosis,… in contrast,

leiomyoma has asymmetrically enlarged uterus)

45. E (pt is already on TMP SMX, so less chance of pneumocystis,

and this is lobar pneumonia, pneumocystis shows interstitial

pneumomnia>> bilateral infiltrates on x ray)

46. A (warm compresses would provide most quick symptomatic

benefit. Compression stockings and enoxaparin therapy are valid

options but would not help with the pain.)

Block 3

1.B (Fragile X syndrome)

2. E (Neuroleptic Malignant Syndrome)

3. C (small cell carcinoma >> SIADH)

4.E (pt took medoxyprogesterone intermittently means she is on

oestrogen therapy alone for some time and now she is having

post-menopausal bleeding, we need to rule out Ca endometrium)

E

5. B

6. D (clue: she comes in the fall)

7. A ( 5mins after giving penicillin) A

8. B (The most common cause of lymphangitis in humans is

Streptococcus pyogenes)

9.B (dorsum of the foot sensory supply is peroneal N) B

10. A (neonatal tetanus)

11. D (Dextrose water is not used for resuscitation; use normal

saline or ringer lactate)

12. C (selenium sulfide shampoo can be used for treatment of

tinea versicolor)

13.B (long bone fracture) B

14. B (young female, low platelet count, absent other physical

findings) B

15.E (postpartum, sudden onset of dyspnea after ambulataion,

hypoxia) E

16. A (look for air under the diaphragm)

17. D (It cannot be excessive Vitamin D because serum

phosphorus is below normal)

18. B diabetes nephropathy, microalbuminuria B

19. B travel, abdominal bloating, steatorrheoa B

20. Q (rings on Prussian blue)

21.H ( anemia on chronic renal failure) H

22. E (anemia plus the whole spectrum of leuopoiesis visible in

peripheral smear plus thrombocytosis, plus philadephia

chromosome ) E

23. J (no prenatal care plus macular rash involving palms and soles

>> think Syphilis)

24. E (referred pain to left shoulder plus left pleural effusion

makes subphrenia abscess more likely )

25. C (blood at urethral meatus >> look for urethral injury)

26. B (Tinea capitis. Can be transmitted by direct contact or

through sharing of combs, hats and clothing.)

27.A (sudeen urge to void + couldn’t make it in time to toilet >>

urge incontinence) A

28. B (septic shock)

29. C

30. A (pale mucosa, cobblestoning)

31. D (contrast nephropathy can be decreased with proper

hydration)

32. E (Hirschsprung disease)

33. C

34. A (passive smoking increases the incidence of ear and throat

infections in children)

35. A

36. E

37. D thiazide side effect>> hypokalemia, >> muscle weakness

D

38. A (Normal aging. She doesn't have dementia. MMSE score of

27 is normal.)

39.A ( white thin woman>> high risk for OP) A

40. D ( impending sense of doom) D

41. C (Juvenile rheumatoid arthritis)

42.G (elderly patient with platelet count normal and mucosa and

skin bleeding>> collagen defect> due to VIt C deficiency) G

43.C ( RA plus splenomegaly plus leukopenia) C

44. C (Ambulatory ECG monitoring is not used to diagnose angina)

45. F (Epiglottitis)

46. B (Febrile seizure)

Block 4

1. D ( sudden deterioration in dementia in elderly< history of

hypertension, barbinski sign on left>> points towards stroke) D

2. E (Mitral Stensis >> Increased pulmonary venous pressure)

3. D (Late decelerations >> fetal hypoxia, placental insufficiency)

4. D

5. C (Start HAART with CD4 below 350 and Pneumocystis

prophylaxis with CD4 below 200)

6. B (Patient fulfills criteria of Major Depression. Start

antidepressants.)

7. C (Polycythemia Vera)

8.E (pneumocystic carnii) E

9. C (suspicion of Mastoiditis)

10. E (clues >> pharmacist, advised to lose weight)

11. B (Epididymo-orchitis in a sexually active young male)

12. D (Acne vulgaris)

13. C

14. D (Abdominal angina. Widespread atherosclerosis makes it

likely.)

15. C

16. E

17. C (Granulosa cell tumor >> excess estrogen)

18. C (Acute poststreptococcal glomerulonephritis >> low C3)

19. A (Hereditary Angioedema. C4 is also decreased in Hereditary

Angioedema, but C1 Estrase Inhibitor's deficiency is the primary

pathophysiology. So while C4 is also the correct answer, I believe

we should prefer C1 Estrase Inhibitor given the causative role it

plays in the disease. )

20. E

21. A (Alzheimer's dementia >> decreased acetylcholine)

22. A (dry mucous membrances, dilated pupils, flushed

appearance)

23. A (Doxorubicin >> cardiotoxicity)

24. E

25. B (patient most likely stopped taking prednisone)

26. G

27. F

28. B

29. B

30. E

31. B

32. E (her rising PCO2 indicates impending respiratory failure)

33. B

34. D

35. C (Pelvic Inflammatory Disease)

36. F

37. A

38. G (Myasthenia gravis)

39. F (obstructive sleep apnea)

40. E

41. A (vegetarian diet predisposes her to B12 deficiency)

42. D

43. B

44. G (buzzword: bag of worms)

45. C (embolism of cardiac myxoma)

46. B

Ps I m not original author of those answers. But I got 15

incorrrects in NBME 4 online and I reviewed them with another

frd who did online and doublechecked those answers, modify

and added some explanations. In the hope that this helps ppl

who wanna do it offline. U can trust answers in here, 99%,(only

3 answers I m not 100% sure) all checked and confirmed with

online.

Pls keep me in ur prayers.

Dr.katherine..

28/5/2014