Hi guys, just took NBME practice test 1 and was wondering if anyone got these questions correct on the practice nbme. An explanation to your reasoning would be really appreciated as well, thanks in advance!
1. 13yo girls brought in for 6 weeks of constant abdominal pressure, breast tenderness, and weight gain. Never had menstrual period. Vitals are normal. Breast and pubic hair Tanner 3. Abdominal exam shows a nontender mass below umbilicus. Next step in diagnosis?
b. measure serum alpha-fetorotein
c. measure serum beta-hCG
d. x-ray of abdomen
e. CT scan of pelvice (WRONG)
No idea what the diagnosis is....
Anyone with amenorrhea always get a beta-hcg to r/o pregnancy, even if they have never had a menstrual period. She could be pregnant, or she could have outflow tract obstruction (or something else).
2. 17yo girl brought to ED after found lying on the street. Outside temp is 40F. En route to hospital, paramedics administered O2 and ECG showed J-wave. She is lethargic and poorly responsive to verbal commands. Temp is 32 (89.6F). Puls = 60, RR = 12, BP = 90/60. There is an odor of ethanol on her breath. Which of the following is most likely explanation for the patient's cardiac findings?
a. cocaine toxicity, b. ethanol toxicity, c. hyperkalemia, d. hypocalcemia, e. hypothermia, f. increased intracranial pressure, g. MI
Again, no idea what the "cardiac finding" is.... Ethanol toxicity was the wrong answer
Cardiac finding is the J-wave on ECG--associated with hypothermia
3. 1week old newborn has 1 day history of difficulty breathing and discoloration of extremities. Appears ill, temp = 97.5, pulse = 160, resp = 52, BP = 60/36 in upper extremities and unobtainable in lower extremities. Skin, mucous membranes, and nail beds are dusky, and there is mottled discoloration of the extremeties. Moderate intercostal retractiosn and grunting. Lungs clear. Holosystolic murmuc along left sternal border. Liver edge palpable 4cm below costal margin.
pH = 7.15, CO2 = 28, O2 = 98
Intubation, mechanical ventilation, and iv fluid initiated, but no improvement one hour later. x-ray shows cardiomegaly and pulmonary congestion. Explanation of this condition?
a. closure of ductus arteriosus
b. deacreased pulm vascular resistance
c. increased pulm vascular resistance
d. intracardiac right to left shunt (Wrong)
e. opening of ductus arteriosus
Again, not sure what the diagnosis/pathology is here. Thought it was a VSD or something and the shunt turned into right to left (although its too early since its a newborn). any explanation of whats going on??
Probably has tetralogy. Closure of the PDA with severe pulmonary stenosis leads to his sudden onset of cyanosis.
4. 3yo comes in for rapid breathing and cant catch his breath. pulse = 100, RR = 30, BP=120/80. lungs clear. slight hyperresonance on right chest. decreased breatah sounds on right. x-ray shows slight overexpansion of right lung compared with left. no infiltrates or effusions. Best management?
a. hyperbaric Oxygen
b. CT of chest
d. Thoracotomy (Wrong)
e. Tube thoracostomy
Pretty sure this was tension pneumothorax and couldnt find thoracocentesis. Didn't really know the difference between thoracotomy and tube thoracostomy (kinda embarrassing). I'm guessing its tube thoracostomy but wanted to check... lol
Thoracotomy is a large incision typically in the lateral chest wall used for CT surgery. Tube thoracostomy (AKA chest tube) is indicated here.
5. 16yo boy comes for routine health exam. Both maternal and paternal family history includes premature coronary artery disease, HTN, and hyperlipidemia. BMI is 35. Cardiac exam no abnormalities. Fasting serum lipids studies show:
Choldesterol (total): 214; HDL: 32, LDL: 144
Best step in management?
a. reduced calorie diet
b. weight training program
c. Beta-blocking agent therapy
d. cholesterol binding resin therapy
e. stating (wrong)
Somehow thought it said dad and paternal grandfather so I was thinking familial hyperchol... I'm guessing its either A or B
He's fat. He needs to lose weight.
I bolded the answers that I believe to be correct.
I'm not sure if anyone will see this, but number 4 is actually bronchoscopy- it's a foreign body aspiration.
So my shelf is coming up and I took the NBME form 2. Was wondering if anyone could help me with these questions as well. Hopefully those who take it in the future will find these helpfull as well.. Thanks in advance!!
1. 2yo has 2week history of irritability, poor appetite, occasional cough, and reluctance to walk. Has had 2kg weight loss since her last exam 6mo ago. No history of reuccrent respiratory illness, constipation, vomiting, or diarrhea. Appears uncomfortable and quiet. 7th%ile for height and 25%ile for weight. Temp = 100.2, Pulse: 140, RR: 24, and BP: 145/100. Bluish discoloration under both eyelids. Cardiac and abdominal exam normal. Labs:
Leukocyte: 8300 (Neu: 40%, Lymph: 55%)
Lateral x-ray of chest shows mass in posterior mediastnum. Diagnosis?
A. anthroax, B. Congenital heart disease, C. CF, D. Dermatomyositis (WRONG), E. Neuroblastoma, F. Pulmonary Sequestration, G. Thymoma, H. TB
Based on the x-ray and high BP my next guess would be Neuroblastoma (arising from the sympathetic chain)... But I dont know what to make of the physical exam findings (bluish under eyelids, reluctance to walk, etc).... Any idea whats going on??
2. Healthy 16yo from Africa has painless lesion on vulva for 4 days. Sexually active with one male and no contraception used. 10-mm, sharply demarcated, elevated, round lesion on right labium majus. Base of the lesion is smooth and nonpurulent. Organism??
A. Chlamydia, B. Gardnerella Vaginitis, C Haemophilus ducrey, D. HSV, E. HPV (WRONG), F. Neisseria Gonorrhea, G. Teponema pallidum, H. Trichomonas vaginalis.
Thought genital warts would present like this. My next guess would be syphillus since I just read that it can present as elevated papule, but I thought it would be ulcerated classically. And why would this NOT be HPV? wouldnt genital warts present like this??
G. Treponema - painless chancre of syphilis
3. 3400g male newborn has decreased muscle tone. Born at GA: 38wks, apgar 6 and 9. Temp: 98.2, Pulse: 150, RR: 60. Pulse oximetry on room shows 92%. Exam shows epicanthal folds, white stellate spots on iris, single palmar crease, truncal hypotonia, and wide spaces between 1st and 2nd toes. Best next step in management?
A. measure creatine kinase and MRI of brain
B. Chest x-ray and blood cultures
C. ECG and chromosomal analysis
D. Give PGE1 and oxygen supplementation (WRONG)
E. Give surfactant and I.V. ampicillin and gentamicin
Thought the best thing to do is give oxygen (and I guess PGE1) because of the low O2 and because he may have a congenital heart defect (due to Down syndrome). I guess his APGAR is good, hes not cyanotic, and pulse is >100 so you don't need to intervene. So I'm guessing ECG and chromosomal analysis is the right answer?
yes C is the right answer
4. 4wk old girl brought in because 2weeks of irritability and passing stools streaked with mucus and blood. No vomiting. 2 weeks ago, switched from cow's milk-based formula to soy milk-based formula. She is at 35%ile for length, weight, and head circum. Weight remains unchanged from 2wks ago. Most appropriate next step is to begin what?
A. Electrolyte rehydration solution for 24hrs (WRONG)
B. Formula with evaporated milk, water, and corn syrup
C. Formula with hydrolyzed casein
D. Oral Amoxicillin
E. Oral Ranitidine
Really don't know whats going on here... I'm guessing its B or C but don't really know what either of those answers mean.
C is the right answer
Thanks in advance guys.
I answered the last 3 questions.I wasnt sure of the first one. hope it helps
What up, ya'll.
I finished reading through Blueprints and figured I'd share my reading notes. I won't say they're completely comprehensive as if you want completely comprehensive you should just read the text, but they're fairly detailed while still being "concise" (by concise I mean 128 pages in Word). You can get it here: https://drive.google.com/file/d/0B2W2KIoJyztwQXJEM0ZUSXBqaGM/edit?usp=sharing
There are multiple references to seeing charts and tables below which intentionally don't refer to anything. They were pictures of the text that I was too lazy to transcribe that I removed for copyright reasons.
Good luck, and happy studying.
So, I suppose I should mention that I did fine, got an A and got essentially the same grade as I did in Family Medicine, so as bad as I thought the exam was, it was apparently on-par and manageable.I just took my Peds Shelf and was honestly blown away by it. Going into it, I did have one disadvantage being that my rotation was 100% outpatient. However, I actually felt like I prepared for this Shelf better and more efficiently than any other exam. I was shocked about how long all my questions were, with a ton of irrelevant lab results. Also, all the main topics for Pediatrics I thought would be on the exam, wasn't. I finished with only 14 minutes to spare to review my marked answers, which is also a first for me.
For my prep: I studied Case Files, First Aid for the Wards (Peds), First Aid for Step 2 CK (Peds section), Kaplan Peds Videos & Notes, all UWorld Peds questions (including repeating all the ones I got wrong, once I finished going through it once), an NBME Peds Shelf Assessment, some Pretest questions (which I hated), and miscellaneous other resources.
It honestly shocks me that with the prep I did, the test felt so foreign to me, though I suppose I will have to wait and see how I did *crosses fingers*
I just took this yesterday. I was confident going into this shelf but it was much tougher than expected. I normally hate it when people say that they thought an exam was challenging bc they could only cut the answers down to 2 choices (bc I usually think that person just didn't study enough) .... buuut that's exactly what happened to me for about half of this test.
I used UW x 1, Pretest x 1, Kaplan vids x 1, BRS x 1, ~20 CLIPP cases, First Aid PEDs as reference.
The question read: "x-ray shows OVEREXPANSION of right lung." In a pneumothorax the lung shrinks in size, not overexpands. In a foreign body aspiration there is air trapping and hence overexpansion of lung due to the presence of a foreign body.soccerboy2288 said:Thanks jayhawkjbc! wow I don't know why I didn't think of that.... but it makes sense now that you mentioned it lol Is there a way to differentiate foreign body aspiration vs tension pneumothorax or was that based on the age group? Some wheezing in the stem would've been helpful... Anyways thank for the input. Any input regarding for the questions I posted below??
Thanks dude.I think so. I had medicine first and my biggest mistake was using too many resources. My strategy for shelves changed to finding things that are manageable to get through while working hard on rotations at the same time. Once I did this my shelf scores went above 90th percentile.
I'd much rather get through a shorter book and have time to go back and review vs trying to finish something like BRS Peds before my times up and not being sure if I retained everything. With that said, I am a slow reader... so trying to get through BRS was hopeless for me.
If anyone knows the answer to any of these, please share (and with an explanation if possible):
1. 15 month old girl has a 1 day history of rash and fever for the last 3 days. She got the MMR 10 days ago. No acute distress, temp is 101.2 F. She has an erythematous maculopapular rash over the face, trunk, and extremities. Which of the following is the most likely explanation for these findings?
A) arthus reaction from preexisting antibody to rubella virus (wrong)
B) delayed type hypersensitivity reaction to rubella antigen
C) immune complex disease from vaccine preservatives
D) replication of a live vaccine virus strain
E) viral dissemination in an immunocompromised host
2. A previously healthy 3 year old girl brought to physician because of a 2-month history of a right-sided limp. The limp is most obvious when she awakens and gradually becomes less noticeable as she plays. She has no recent history of fever, rash, or other illness and has not been exposed to pets or ticks. Today she appears well but walks with a limp. Temp is 98.2 F. No rash, normal pupils, normal red reflex, normal pharynx, normal cardiac exam. Right knee is swollen and warm but not erythematous or tender. The patient holds the right lower extremity in a slightly flexed position and will not fully extend it when she stands or walks. Laboratory studies show:
ESR 64 mm/h
Rheumatoid Factor -
ASO titer -
Lyme Ab -
In addition to the administration of naproxen, what's the best next step?
A) slit lamp exam
B) Bartonella henselae titer
C) Upper GI series
E) Surgical Aspiration of the right knee (wrong)
3. An 18 hour old female newborn is being evaluated bc of jaundice. She was born at term following an uncomplicated pregnancy and spontaneous vaginal delivery to a 31 year old woman, G2P1. She weighed 3799 g/8 lb 6 oz at birth. Mother's blood group is O+. Newborn has urinated twice but has had no bowel movements. Urine is dark yellow. She has had difficulty latching onto the breast correctly. She is alert. Exam shows jaundice of the face and chest. Abdomen is soft. Liver edge palpated 1 cm below the right costal margin, and the spleen tip is palpated 1 cm below the left costal margin. Serum total bilirubin is 11.1 with direct component of 0.1. What's the most likely diagnosis?
A) Breast milk jaundice
C) Hemolytic disease of the newborn
D) Physiologic jaundice of the newborn (wrong)
E) Sickle cell disease
4. An 8 year old girl brought to physician because of pallor and easy fatigability for the past 2 months. Symptoms began after URI. She was adopted, and her family history is unknown. She appears pale, spleen tip palpated 2 cm below left costal margin. Her HCT is 28%, retic count is 4% with 3+ spherocytes. Splenectomy is most likely to prevent which of the following complications?
B) esophageal varices
C) overwhelming sepsis
D) painful crises
5. A 10 year old girl is brought to the the emergency department following a generalized tonic clonic seizure. She has a 1 month history of behavior disturbances and a 2 week history of fever, weakness, and painful swelling of the left knee. Her hemoglobin concentration is 9, leukocyte count is 3800, platelet count is 65K. Coomb's test is positive. UA shows protein and microscopic blood. What's the most likely diagnosis?
A) Hodgkin disease
B) Henoch Schonlein Purpura
D) Systemic lupus erythematosus
E) Viral encephalitis (wrong)