NBME Form 9 Practice Test

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• Neonate that improved with positive pressure ventilation (PPV) can be taken off PPV immediately after improvement.
• Which combination is commonly used as second-line therapy for ulcerative colitis when initial therapy fails?
• A 47-year-old asymptomatic man with a maternal grandmother who had colon cancer at 47 years old (not a first-degree relative). What is his colorectal cancer risk status and recommended screening?
• True or False: The most significant risk factor for Alzheimer's disease is advancing age.
• In a patient with suspected occult hip fracture and a normal X-ray, which imaging modality is indicated next to best detect occult injury?
• Which of the following is a first-generation cephalosporin commonly used for perioperative prophylaxis due to activity against Staphylococcus aureus and streptococci?
• Which metric measures how well a test identifies those without disease?
• A postpartum patient with depressive symptoms 6 weeks after delivery most closely corresponds to which diagnosis?
• A 4-year-old boy with 3 days of fever, cough, runny nose, and no chest congestion or SOB is most likely diagnosed with:
• T/F: Patients with chronic respiratory acidosis will retain CO2 as bicarbonate and therefore have increased bicarbonate.
• Which fibroid subtype is most strongly associated with heavy menstrual bleeding and infertility due to distortion of the uterine cavity?
• Initial step to controlling allergic rhinitis can include pillow and mattress covers.
• Which finding is most characteristic of prepatellar bursitis rather than chondromalacia patella?
• Stevens-Johnson syndrome management requires admission to which level of care?
• A prevalence ratio less than 1.0 indicates which of the following?
• A 52-year-old woman recently had cholecystectomy and now has elevated urea, bilirubin, and AST with a normal abdominal ultrasound. What is the most likely diagnosis and next step?
• Osteosarcoma most commonly occurs in patients younger than 30 years old. Which option best describes this peak incidence?
• A 77-year-old presents with 1 day hx of nausea, vomiting, confusion; HTN; on diltiazem; BP 160/70; oxygen saturation 84%; JVD borderline high; crackles in lungs; S3; edema; signs of kidney injury. Dx and next step?
• Stevens-Johnson syndrome or toxic epidermal necrolysis should be managed with:
• In a young woman with heavy menses, which history finding would most strongly suggest von Willebrand disease?
• Which antibiotic is commonly used to treat primarily Gram-positive infections with some Gram-negative coverage (e.g., E. coli)?
• A 48-year-old woman presents with abnormal uterine bleeding and a 2.5 cm submucosal fibroid on imaging. What is the diagnosis and most appropriate management?
• In a patient with signs of fluid overload and kidney injury, which therapy is most definitive?
• A postoperative patient with alcoholism presents with blurred vision, nystagmus, amnesia, and ataxia. Which diagnosis is most likely?
• Arrest of labor is diagnosed when there is no cervical change for greater than _____ hours with adequate contraction.
• Which lipid assessment combination can be sufficient to evaluate cardiovascular risk in some patients?
• What is the standard perioperative antibiotic for surgeries such as total knee replacement?
• Which screening test is recommended annually to monitor brain involvement in neurofibromatosis type 2?
• Initial treatment for postpartum endometritis typically includes which regimen?
• Most umbilical hernias in children older than 3 years that are greater than how many centimeters in diameter are likely to continue enlarging?
• Which imaging modality is cited for evaluating a thyroid nodule before surgery?
• In active stage, cervix must dilate at least ______ cm per hour.
• Which description best fits actinic keratosis?
• Unstable angina requires outpatient exercise stress testing.
• Which organism is a recognized risk factor for postpartum endometritis?
• Protraction of labor during active labor should be managed initially with C-section.
• Aminoglycosides (gentamicin) are contraindicated in pregnancy.
• Which is the most concerning obstetric complication associated with placenta previa and prior cesarean deliveries?
• A 72-year-old woman with 3 days of bright red rectal bleeding, preserved cardiac function, fever of 103°F, left-lower-quadrant tenderness, and hypotension. What is the most likely diagnosis?
• In adults, destructive bone lesions are more commonly caused by which disease rather than primary bone malignancy?
• Which therapy is used after renal biopsy confirms FSGS?
• In a patient with a single pancreatic lesion and pancreatic duct obstruction but no masses, the most likely diagnosis is pancreatic cancer. What is the recommended definitive treatment?
• Which physical sign is most indicative of gastric outlet obstruction?
• Which statement best describes medication-induced depressive symptoms?
• The proportion with the lowest false negative rate will have the highest which measure?
• For a patient with unstable sustained VT lasting more than 30 seconds, what is the first-line treatment?
• Which performance metric is maximized when the false negative rate is minimized?
• The proportion of positive test results most affects which metric?
• Which lab finding would most support diverticulitis over ischemic colitis in an elderly patient with left lower quadrant pain?
• Second-line therapy for ulcerative colitis?
• Worsening stable angina is reclassified as which condition?
• In neurofibromatosis type 2, which screening test should be performed annually to monitor brain involvement?
• A 22-year-old woman with one week of left knee pain after a basketball game 8 days ago, knee effusion, and tenderness over the medial joint line. Most likely diagnosis?
• What is the first-line treatment for Meniere’s disease?
• Ethical stance on placebo in trials when standard life-saving treatment exists?
• T/F: LABA are the main daily treatment for chronic COPD patients.
• In the described trauma scenario, the nasogastric tube deviation to the right in the upper mediastinum most strongly suggests injury to which structure?
• For suspected adrenal insufficiency, which initial test is commonly used?
• Protraction of labor during active labor should be managed initially with oxytocin and prostaglandins to assist in cervical ripening.
• Which finding is NOT typically associated with pediatric idiopathic pulmonary hypertension?
• What is the treatment for individuals who have allergies to bee stings and develop anaphylaxis?
• What dilation marks the end of the latent stage?
• Progesterone therapy in amenorrheic patients is given and withdrawn. If menses occurs after withdrawal, then the most likely cause is _______.
• True or False: The most significant risk factor for Alzheimer's disease is genetics.
• Which feature best indicates a thyroid origin for a neck lump?
• First-line therapy for mild to moderate acne vulgaris?
• A prevalence ratio greater than 1.0 indicates which of the following?
• In the sequence for suspected FSGS, which test is used to confirm the diagnosis?
• When there is suspected focal segmental glomerulosclerosis (FSGS), what is the next step?
• A screening test used to detect uveitis in juvenile idiopathic arthritis is which?
• Which practice helps prevent worsening of diabetic foot injuries?
• A 4-year-old presents with a 2-day history of increasingly severe right leg pain and limp. He has the hip flexed and externally rotated, passive ROM limited by pain. X-ray is normal and there is no history of falls or trauma. What is the most likely diagnosis and the next step?
• Cephalosporins are often used for surgical prophylaxis and in the treatment of skin and soft tissue infections.
• In evaluating HbA1c threshold performance for retinopathy, what does a reported 88% specificity indicate?
• What measure is recommended to prevent foot injuries in diabetic patients?
• In cervicitis during pregnancy, which organism is azithromycin commonly used to treat?
• In a pediatric patient with suspected transient synovitis versus septic arthritis causing limp, which investigation helps differentiate the two conditions?
• What is the first diagnostic step for a mandibular mass in an elderly patient?
• Which feature is most consistent with chronic pancreatitis rather than acute pancreatitis?
• In suspected pertussis, which test best confirms the diagnosis?
• Stevens-Johnson syndrome and toxic epidermal necrolysis typically require admission to which unit?
• Which ocular infection is most likely in a septic patient with sun-exposure risk factors and patchy retinal infiltrates?
• Which test provides cytology to confirm a thyroid nodule diagnosis?
• COPD daily management should include which of the following?
• In patients without risk factors who are aged 40-45, how often should cholesterol screening be performed?
• In a 92-year-old patient with a progressively enlarging left mandibular mass, a normal radiograph, and smoking history, what is the most appropriate next step?
• First-line therapy for ulcerative colitis?
• A 4-year-old boy presents with a 5-day history of increasing right leg pain with limp. He was treated for an ear infection previously. His hip is flexed and externally rotated with limited ROM due to pain. X-ray is normal and he fell 7 days ago. What is the most likely diagnosis and the next step?
• Arrest of labor with inadequate contractions is diagnosed when there is no cervical change for greater than ______ hours.
• In amenorrhea due to HPA axis impairment, withdrawal of progesterone therapy would most likely result in which of the following?
• A diver with sinus pain, congestion, and nasal discharge after diving has which diagnosis and what is its pathophysiology?
• A 42-year-old with a non-tender lump on the right side of the neck that moves with swallowing and has no lymphadenopathy most likely has which diagnosis, and which test confirms it?
• Late-night salivary cortisol concentration is used to diagnose which condition?
• In a patient with heart failure and an ejection fraction below 50% who also has aortic stenosis but is asymptomatic for shortness of breath on exertion, what is the recommended initial management?
• In a study, a prevalence ratio of 0.6 for a disease comparing Group A to Group B implies which group has the higher disease prevalence?
• Which fibroid type projects to the exterior of the uterus and is least likely to cause abnormal uterine bleeding?
• Which statement best describes decompression sickness?
• Struvite and cystine calculi are ______ renal calculi.
• Which knee condition presents with acute anterior knee swelling and erythema in a cleaning worker?
• Progesterone therapy in amenorrheic patients is given and withdrawn. If menses does NOT occur after withdrawal, then the most likely cause is _______.
• Which statement about chronic respiratory acidosis is false?
• What is the pathophysiology behind sinus barotrauma in divers?
• For initial evaluation of suspected renal stones, which imaging modality is commonly used due to high sensitivity?
• Which of the following is included in COPD daily management according to the material?
• Which statement best describes the management of Menière’s disease according to the material?
• Which chemotherapeutic agent is most commonly associated with dilated cardiomyopathy leading to congestive heart failure?
• If HbA1c greater than 15% predicts diabetic retinopathy and 88% of patients without retinopathy have HbA1c less than 15%, what is the specificity of the threshold?
• Which of the following has a risk of triggering mania in bipolar disorder when used alone?
• A 24-year-old college student with 20 days of intermittent heavy vaginal bleeding with clots, fatigue, lightheadedness, and irregular menses but no bruising. What is the most likely cause of heavy menses?
• Which procedure may be considered as the next step after performing endocervical curettage during evaluation of glandular atypical cells on a Pap smear?
• Which statement describes the diagnostic description of the neck lump in the material?
• Which event marks the end of the first stage of labor?
• A patient presents with a wide QRS complex tachycardia, no identifiable P waves, and tachycardia; the patient is 72 with history of heart disease and collapsed. What is the most likely diagnosis?
• Which statement about acute vs chronic respiratory acidosis is true?
• In chronic pancreatitis with calcifications and pancreatic duct obstruction on MRCP, no masses are seen. What is the most appropriate initial management?
• Aspartame is commonly associated with diarrhea.
• Latent stage of labor (1st stage) ends when the cervix is dilated to ______ cm.
• Most umbilical hernias regress by how many years of age?
• A patient with a first-degree relative who had colon cancer before age 60 has what relative risk compared to average?
• In chronic respiratory acidosis, pH falls by _____ for every increase of 10 mmHg in PCO2.
• GI surgeries prophylaxis commonly uses which antibiotic combination?
• A 32-year-old immigrant from China with BCG vaccination and a PPD of 12 mm has which risk status and recommended management?
• Which statement about postpartum endometritis is true?
• Which statement reflects medication-induced depressive disorder?
• In an amenorrheic patient with suspected estrogen deficiency, withdrawal of progesterone therapy would most likely result in which of the following?
• A 72-year-old woman presents with sudden 3-day history of bright red rectal bleeding and a history of diverticular disease. She has a low ejection fraction and hypotension but is afebrile. Which diagnosis is most likely?
• Support group psychotherapy is validated for depressive disorders. Which option reflects the correct stance?
• Actinic keratosis most commonly occurs on which areas of the body?
• Is LDL cholesterol essential for assessing cardiovascular risk?
• VWD usually presents with irregular menses. Is this statement true or false?
• A hyperkeratotic, erythematous crusted plaque with areas of ulceration in a solid organ transplant patient is most likely which diagnosis?
• The proportion with the lowest false positive rate will have the highest which measure?
• Which medication among the following is commonly used as a mood stabilizer in bipolar disorder?
• 24-hour urine free cortisol testing is used to diagnose which condition?
• For a hemodynamically stable patient with sustained VT lasting more than 30 seconds, which of the following is considered first-line therapy?
• Nonsteroidal anti-inflammatory drugs (NSAIDs) affect renal function by:
• A common extra-articular manifestation of juvenile idiopathic arthritis?
• For pulseless sustained VT lasting more than 30 seconds, what is the first-line therapy?
• An ECG shows narrow QRS complexes with no P waves in between QRS complexes, with only T waves visible. What is the most likely diagnosis?
• Subserosal fibroids are likely to cause postmenopausal bleeding. True or False?
• A patient with bicarbonate of 30, high CO2, and low pH is likely to have _____ respiratory failure.
• Average-risk individuals should begin colorectal cancer screening with colonoscopy at what age?
• In obstetrics, forceps or vacuum delivery requires the fetal station to be at least at which level?
• In acute respiratory acidosis, pH falls by _____ for every increase of 10 mmHg in PCO2.
• Which bipolar medication is commonly used for bipolar depression as part of treatment options?
• Which vitamin deficiency is most commonly associated with Roux-en-Y gastric bypass?
• A patient with bicarbonate of 25, high CO2, and low pH is likely to have _____ respiratory failure.
• In Crohn disease presenting with signs of small bowel obstruction, what is the most likely cause of the obstruction?
• Which physical finding is most indicative of gastric outlet obstruction?
• If FSGS is suspected and later confirmed with renal biopsy, which therapy is indicated as the next step?
• Acidosis happens if pH is less than ___ .
• Osteosarcoma is most commonly diagnosed in patients in which age range?
• Severe aortic stenosis with significant symptoms or systolic dysfunction (EF < 50%) should be treated with which intervention?
• A diver with joint pain, pruritus, paralysis, hypoxemia, dyspnea, wheezing, and AMS after ascent most likely has which diagnosis and pathophysiology?
• COPD exacerbations can be treated with which set?
• After colposcopy with endocervical curettage in a patient with Pap showing atypical glandular cells, what can be considered as the next step?
• A patient with exercise-induced asthma; which is the first-step therapy?
• Which of the following is an example of a first-line antiarrhythmic for stable sustained VT?
• The proportion of individuals with a positive test primarily affects which predictive value?
• An elderly patient with left lower quadrant pain and fever is more likely to have which diagnosis?
• In a patient without atrial fibrillation but with a history of TIA or stroke, which therapy is indicated?
• True or false: HDL and total cholesterol can be sufficient to assess cardiovascular risk.
• A 22-year-old woman who works as a cleaning lady presents with one week of left knee pain with acute onset, erythema, swelling over the anterior knee, and pain on knee flexion. Most likely diagnosis?
• A 47-year-old man with a mother who had colon cancer at 47 years old (first-degree relative). What is his risk status and recommended screening?
• An 8 AM serum cortisol level is used in diagnosing which adrenal condition?
• MRCP showing calcifications and a pancreatic duct obstruction without a discrete mass most strongly indicates which condition?
• Which performance metric is maximized when the false positive rate is minimized?
• Low-dose overnight dexamethasone suppression test is used for diagnosing which condition?
• If a patient has a cephalosporin allergy and needs perioperative prophylaxis for orthopedic surgery, which options may be used?
• Active stage of labor (1st stage) ends when the cervix is ______.
• In a clinical trial, can placebo be dropped if there is readily available standard treatment that could be life-saving?
• A fetus at a station of -1 cannot undergo forceps or vacuum delivery. True or False?
• Arrest of labor should be managed with C-section.
• The majority of renal calculi are radiopaque and can be visualized with which imaging modality?
• A bipolar patient with acute depressive relapse after stopping medications should be treated with which of the following?
• For evaluating a thyroid nodule before a surgical procedure, which test is used?
• In atrial fibrillation with a history of TIA or stroke, which therapy is indicated?
• Submucosal fibroids are likely to cause postmenopausal bleeding. True or False?
• A 37-year-old woman with no history of abnormal Pap smears has a Pap smear showing atypical glandular cells. Which is the potential diagnosis and the next step?
• True or False: Steroids and antihistamines can be used to prevent anaphylaxis from bee stings.
• The proportion of individuals with a negative test primarily affects which predictive value?
• A 47-year-old unrestrained motor vehicle collision patient with hypotension and chest pain shows left base fluid on imaging and the nasogastric tube deviates to the right in the upper mediastinal region. What is the most likely diagnosis?
• Steroids are useful in Stevens-Johnson syndrome.
• A 22-year-old woman with six months of left knee pain after a basketball game a year ago, with giving way and worse on stairs, patellar tenderness, BMI 46. Which diagnosis is most likely?
• What does the attributable risk formula represent?
• Hyponatremia is associated with confusion when serum sodium falls below which threshold?
• In a 57-year-old patient with postmenopausal bleeding and a 2.5 cm subserosal fibroid, what is the most likely diagnosis and the appropriate next step?
• In delirium tremens, which electrolyte abnormality is more common?
• Thiamine (Vitamin B1) is primarily absorbed in which part of the small intestine?
• Which stage of labor encompasses the latent and active phases and ends with complete cervical dilation and effacement?
• A woman is evaluated 6 weeks after delivery for persistent depressed mood, anhedonia, insomnia, and feelings of worthlessness. The most likely diagnosis is:
• In a child with bed-wetting and constipation, which treatment is most appropriate as first-line?
• An elderly alcoholic with sepsis and fundoscopic exam showing patchy white retinal infiltrates bilaterally without papilledema most likely has which diagnosis?
• What is the best management for a subconjunctival hemorrhage in a stable patient with no ocular pain or abnormal exam findings?
• Which radiographic sign on chest imaging is strongly associated with traumatic aortic injury in blunt chest trauma?
• Light pink, ill-defined macules with gritty texture in sun-exposed areas of a farmer most likely represents which condition?
• Primarily used in the treatment of Gram-negative infections such as UTIs.
• Which condition describes abnormal placental attachment to the myometrium?
• 37-year-old Gravida 5 with anterior placenta previa at 21 weeks and five prior cesarean deliveries is at greatest risk for which condition?
• Arrest of labor management: which statement is true?
• Which perioperative antibiotic regimen provides gram-negative and anaerobic coverage for GI surgeries?
• A 47-year-old man with shortness of breath during activity and at rest for 24 hours has a history of chemotherapy with doxorubicin 4 months ago. Resting pulse was elevated during treatment and his current ejection fraction is 40% with sinus tachycardia on ECG. What is the most likely diagnosis and its pathophysiology?
• A 44-year-old woman with a two-week history of a nonproductive cough that worsens at night, with no fever or weight loss, began after a sore throat and catarrhal phase. The most likely diagnosis and the next best test?
• Which statement is NOT part of the typical management for Stevens-Johnson syndrome/toxic epidermal necrolysis?
• A patient with Crohn disease presents with severe upper abdominal discomfort, vomiting that is relieved by vomiting, distension, and a succussion splash. The most likely diagnosis is?
• Basal cell carcinomas have hyperkeratotic crust.
• In a child older than 3 years, an umbilical hernia measuring 1 cm is most likely to:
• Which aminoglycoside is primarily used to treat Gram-negative infections such as urinary tract infections?
• Why should SSRIs be used cautiously in bipolar patients?
• Twenty-four-year-old woman, 28 hours after vaginal delivery, presents with fever and diffuse tenderness on bimanual exam and a tender uterus. Most likely diagnosis and next step?
• A 24-year-old with 20 days of constant heavy vaginal bleeding with clots, fatigue, bruising, and regular menses. What is the most likely cause of heavy menses?
• In a pregnancy with multilobate placenta and velamentous cord insertion at 21 weeks, what fetal complication is the patient at greatest risk for?
• Which statement accurately describes the relationship between stable and unstable angina?
• Multiple myeloma is characterized by proliferation of which type of B cells?
• The latent stage and the active stage are subdivisions of which stage of labor?
• Cephalosporins have no role in treating Chlamydia.
• CT scan is better for nephrolithiasis than plain X-ray.
• When a Pap smear shows atypical glandular cells and endometrial malignancy is a consideration, which diagnostic test is used to evaluate for endometrial pathology?
• Ultrasound can be useful for detecting _____ renal calculi.
• What is the second-line therapy for refractory Menière’s disease?
• A 52-year-old woman with type 2 diabetes presents after 24 hours of vomiting. Her sodium is 127 mEq/L and glucose is 890 mg/dL. What is the likely diagnosis and its pathophysiology?
• Which is a risk factor for endometritis after delivery?
• A 32-year-old woman from a high TB prevalence country with BCG vaccination and a PPD of 12 mm has which risk status and recommended next step?
• Which sugar alcohol, when consumed in excess, can cause osmotic diarrhea, bloating, and abdominal discomfort?
• T/F: Oral steroids are the main daily treatment for chronic COPD patients.
• Which of the following is a standard component of COPD exacerbation management?
• Which electrolyte abnormality can be seen in delirium tremens?
• Unstable or worsening angina typically requires inpatient observation.
• In adults with destructive bone lesions, which etiology is most likely?
• Which management step is most appropriate for unstable ventricular tachycardia with a pulse?
• A diver presenting with AMS, chest pain, dyspnea and wheezing after ascent is most likely to have which condition and what is the pathophysiology?
• In blunt chest trauma with suspicion of aortic injury, what radiographic feature is the most concerning sign?
• A pregnant woman at 8 weeks gestation presents with heavy mucopurulent discharge and a friable cervix. The most likely diagnosis is acute cervicitis, and the next step is azithromycin.
• In a cephalosporin-allergic patient undergoing surgery, which agents are appropriate alternatives for perioperative prophylaxis?
• A Crohn disease patient presents with abdominal pain, vomiting, distension, hypotension, and decreased bowel sounds suggesting a small bowel obstruction. What is the most likely diagnosis?