Step 2, NBME 6

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1. First step in management of -IV calcium 19. Classic triad of wernicke- -confusion
hyperkalemic patient with EKG changes? gluconate korsakoff? -opthalmoplegia (with
nystagmus)
2. Treatment for small, cutaneous -no intervention
-ataxia
hemangiomas? is necessary
20. Clinical features of myotonic -myotonia
3. What factors can decrease libido? List in 1. decreased
muscular dystrophy? -muscle wasting
order of importance? androgens
-difficulty relaxing grip
2. decreased
-testicular atrophy
progesterone
-cataracts
4. Cause of huntington's disease? -CAG repeat on -frontal baldness
chromosome 4
21. Cause of spontaneous -infected ascitic fluid
5. Presenting features of HD? -movement bacterial peritonitis?
(choreiform)
22. Most common causes of -e. coli
-memory
SBP? -klebsiella
(dementia)
-strep pneumo
-mood
(personality 23. How is diagnosis of SBP -paracentesis as well as
changes) established? gram stain, culture, and
sensitivities of fluid
6. Personality changes in HD can progress -psychosis
to...? 24. Diagnostic criteria for SBP? -WBC > 500
-PMN > 250
7. Treatment options for psychosis in HD? -haloperidol
-quietapine 25. Options for malaria -mefloquine
prophylaxis? -chloroquine
8. What does head CT or MRI in HD show? -caudate nucleus
involvement 26. When is mefloquine -for travel to chloroquine-
prescribed? resistant areas
9. Next step in pediatric patient with -water-soluble
bloody stools and normal XR? contrast enema 27. When is chloroquine -when chloroquine
prescribed? resistance has not been
10. What is vitamin B1 also known as? -thiamine
reported
11. Findings in vitamin B1 deficiency? -berberi
28. Symptoms of -anxiety
-wernicke's
benzodiazepine withdrawal? -tremulousness
encephalopathy
-fatigue
12. What is vitamin B2 also known as? -riboflavin
29. What are the seronegative -arthritis without rheumatoid
13. Symptoms of vitamin B2 deficiency? -angular chelosis spondyloarthropathies? factor
-stomatitis
30. List the seronegative -P: psoriatic arthritis
-glossitis
spondyloarthropathies? -A: ankylosing spondylitis
14. What is vitamin B3 also known as? -niacin -I: inflammatory bowerl
15. Syndrome of vitamin B3 deficiency? -pellagra disease
-R: reactive arthritis
16. Features of pellagra? -diarrhea
-dermatitis 31. Lab studies are most likely to -HLA-B27
-dementia show what finding in these
-death patients?

17. Symptoms of dry beriberi? -polyneuritis 32. Characteristic findings in -psoriasis

-symmetrical psoriatic arthritis? -asymmetric arthritis
muscle wasting -dactylitis (sausage-fingers)

18. Symptoms of wet beriberi? -high-output 33. XR finding in psoriatic -"pencil-in-cup" deformity
cardiac failure arthritis?
-edema 34. Findings in ankylosing -anklyosis
spondylitis? -decreased spinal ROM
-uveitis
-aortic regurgitation
35. Classic triad in reactive -conjunctivitis 51. Echocardiographic finding in -diffuse hypokinesia and
arthritis? -urethritis viral cardiomyopathy? dilation of the ventricles
-arthritis
52. Clinical features of pompe -cardiomegaly
36. Reactive arthritis occurs -shigella disease? -hypertrophic
after infection with...? -salmonella cardiomyopathy
-yersinia -hepatomegaly
-campylobacter -hypotonia
-chlamydia
53. First step when a patient -arthrocentesis
37. First step in the -CBC presents with septic arthritis?
evaluation of pica?
54. In what period of sleep do -non-REM sleep
38. Dehydration results in the -hyaline troubling dreams occur during
formation of what type of sleep terror disorder?
casts?
55. Implications in terms of -no memory of sleep
39. Disease suggested by -CGD memories of troubling during terror
recurrent lymphadenitis dreams?
in children?
56. During what period of sleep do -REM sleep
40. Cause of CGD? -impaired phagocytic oxidative troubling dreams occur during
mechanism nightmare disorder?
41. What bacteria are most -staphylococcus 57. Implications? -dreams are recalled
likely to cause infection -burkholderia during nightmare disorder
in CGD? -nocardia
58. Triggers of sleep terror -emotional stress
-aspergillus
disorder? -fever
42. Treatment for someone -observation in the ED -lack of sleep
who is high on marijuana?
59. Treatment for worrisome -topical retinoic acid
43. First-line/immediate -corticosteroids stress-induced acne?
treatment required in
60. Most likely diagnosis in patients -hemothorax
cases of temporal
with symptoms of PTX but with
arteritis?
opacification on XR?
44. Most effective tool to -negotiate a contract regarding
61. Next step when rapid stress test -throat culture
ensure that non- medication compliance
is negative in patient with high -->a negative test is not
compliant patient
clinical suspicion for strep always sufficiently
becomes compliant?
pharyngitis? sensitive to exclude
45. Characteristic murmur in -continuous, machine-like disease
persistent PDA? murmur/to-and-fro murmur
62. Next step when -laparotomy
heard loudest at the second
pneumoperitoneum is detected
intercostal space
on CXR?
46. Other features of -labored breathing
63. First-line treatment for SIADH? -fluid restriction
persistent PDA? -bounding peripheral pulses
-widened pulse pressure 64. Do you follow the wishes of a -yes
patient that does not wish to
47. What occurs in gallstone -fistula forms between
know information about their
ileus? gallbladder in biliary tree
health/prognosis?
48. What does this allow for? -passage of gallstones into the
65. When is the only time that -in a hypoglycemic patient
intestinal tract
D50% in water is indicated?
49. A gallstone in the -obstruct the ileocecal valve
66. What is cystourethrocele? -bulging of the bladder
intestinal tract may
and urethra into the
then...?
vagina
50. Imaging feature of -air in the liver
67. Cause of increase in WBC count -glucocorticoid-induced
gallstone ileus?
after administration of steroids? demargination and
storage pool release of
segmented neutrophils
68. Presenting features of multiple -C: hyperCalcemia 88. What are the two types of pleural -transudative
myeloma? -R: renal involvement effusion? -exudative
-A: anemia
89. Causes of transudative effusion? -CHF
-B: bone lytic
-cirrhosis
lesions/back pain
-nephrotic
69. Blood smear feature in multiple -rouleaux formation syndrome
myeloma? -peritoneal
dialysis
70. XR features in multiple myeloma? -"punched-out"
bone lesions 90. Causes of exudative effusion? -bacterial
pneumonia
71. Cause of heat stroke? -inadequate
-tuberculosis
dissipation of body
-viral infection
heat
-malignancy
72. Most common cause of DVT in the -hypercoagulable -metastatic
post-partum period? state of pregnancy disease
73. Most likely diagnosis when -intraductal lesion 91. Features of exudative effusions? -protein > 0.5
serosanguinous fluid can be (likely papilloma) -pleural
discharged from a breast? LDH/serum LDH
74. CXR pattern in pneumocystis jiroveci -diffuse alveolar and > 0.6
pneumonia? interstitial pattern -LDH > 2/3 the
upper limit of
75. Cause of increased CP in patients -obstruction of CSF
normal serum
with myelomeningocele or other flow
LDH
neural defect?
92. List the paraneoplastic syndromes -SIADH
76. Hypersplenism can cause what -thrombocytopenia
associated with lung cancers? -ectopic ACTH
disorder of blood cells?
-PTH-like
77. Shared side effect of carbamazepine -bone marrow hormone
and phenytoin? suppression secretion
78. Muddy brown casts are indicative of -acute tubular -eaton-lambert
what condition? necrosis syndrome

79. Diagnostic work-up in patients with -electromyography 93. Lung cancer associated with SIADH? -small cell
suspected guillain-barre? and nerve carcinoma
conduction studies 94. Lung cancer associated with ectopic -small cell
80. Next step in management of patient -nonstress test ACTH? caricnoma
at 38w GA with no fetal movement 95. Lung cancer associated with PTH-like -squamous cell
for 36 hours? hormone secretion? carcinoma
81. Imaging modality used to diagnose -abdominal CT 96. Lung cancer associated with eaton- -SCLC
diverticulitis? lambert syndrome?
82. Greatest risk factor for pre-term -previous pre-term 97. Most appropriate therapy for -amphotericin B
delivery in any patient? delivery cryptococcal meningitis?
83. Two primary types of bony -osteolytic 98. Intrathoracic mass associated with -thymoma
metastases? -osteoblastic myasthenia gravis?
84. Prostate cancer demonstrates what -osteoblastic 99. Long-term, IM form of haloperidol? -haloperidol
type of lesions? decanoate
85. Multiple myeloma demonstrates -osteolytic 100. Most appropriate next step in -heparin therapy
what type of lesions? management when ventilation-
86. Other type of osteoblastic -none perfusion scan shows areas of
metastases? -->prostate only mismatch?

87. Other causes of osteolytic lesions? -lung cancer 101. Most appropriate next step in -CT scan of the
-thyroid cancer management when there is concern for head
-kidney cancer mastoiditis?
102. First step following the diagnosis of -daily exercise 119. Diagnosis: crepitus in the neck -esophageal perforation
PAD via abnormal ABI? program and moderate epigastric
-->confirmatory tenderness following
study with esophageal procedure?
arteriography is not
120. Treatment for coarctation of the -operative treatment
necessary
aorta?
103. Cause of bacterial vaginosis? -gardnerella
121. Treatment for acute gout attack? -NSAIDs
104. Symptoms of BV? -fishy odor -glucocorticoids
-gray-white -colchicine
discharge
122. Chronic treatment options for -allopurinol
105. How is BV diagnosed? -saline wet mount gout? -febuxostat
shows clue cells
123. MOA of both of these -xanthine oxidase
106. Treatment for BV? -metronidazole or medications? inhibitors
clindamycin
124. Appearance of gout crystals? -needle-shaped
107. Symptoms of candida albicans? -white, cheesy -negatively birefringent
vaginal discharge
125. NSAID commonly used in the -indomethacin
108. Diagnostic feature of candida? -KOH shows treatment of acute gout flares?
pseudohyphae
126. Most common mechanism of -overflow incontinence
109. Treatment for candidiasis? -miconazole incontinence in diabetic from acontractile
-clotrimazole patients? bladder
-econazole
127. Common features of complex -staring spells with
-nystatin
partial seizures? repetitive movements
110. Symptoms of trichomonas vaginalis? -profuse, green, (lip smacking, picking)
frothy vaginal -episodes of abnormal
discharge smells (like burnt rubber)
with intense hissing
111. Diagnostic feature of trichomonas? -saline wet mount
episodes
shows motile
flagellates 128. Most serious complication of -ARDS
near-drowning within 36 hours
112. Treatment for trichomonas? -treat both patient
after the event?
and partner with
metronidazole 129. What causes ARDS in near- -alterations in surfactant
drowning events?
113. What is used to make a diagnosis of -echocardiography
cardiac tamponade or effusion 130. Impact of aspiration of -decreases
following concerning CXR? freshwater on serum concentration of serum
electrolytes? Why does this electrolytes due to
114. Symptoms of vitamin C deficiency? -ecchymoses
occur? increased blood volume
-follicular
hemorrhage 131. Impact of aspiration of salt water -increases concentration
-hypertrophied gums on serum electrolytes? Why of serum electrolytes
does this occur? due to decreased blood
115. Preferred treatment for malignant -nitroprusside
volume
hypertension?
132. What classes of medications can -ACEIs/ARBs
116. Preferred treatment for -hydralazine
be used to prevent progression
hypertensive urgency?
of renal disease in diabetics?
117. Preferred treatment for malignant -hydralazine
hypertension in pregnancy?
118. In addition to beginning IV -anti-emetic therapy
hydration, initial step in
management of hyperemesis
gravidarum?
133. Features of lead poisoning? -lines on gingivae and on metaphyses of long bones
-encephalopathy
-abdominal colic
-sideroblastic anemia
-wrist and foot drop
-basophlic stippling of RBCs
134. First-line treatment for lead poisoning? -dimercaprol
-EDTA
135. What lead chelator is used in children? -succimer
136. Treatment for young patients with uncomplicated anal fissures? -anesthetic ointment and stool softeners
137. Cause of adrenoleukodystrophy? -disrupted metabolism of very long chain fatty acids
138. What does this lead to? -build-up within the nervous system, adrenal gland,
and testes
139. MRI findings in adrenoluekodystrophy? -marked symmetric white matter disease involving all
lobes
140. What impact can lithium have on thyroid function? -lithium can cause hypothyroidism
141. Features of NF type 1? -cafe-au-lait spots
-lisch nodules
-cutaneous neurofibromas
-optic gliomas
-pheochromocytomas
142. What are lisch nodules? -pigmented iris hamartomas
143. Most effective treatment for acute renal transplant rejection? -increased dosage of corticosteroids
144. First line treatment for panic attacks? -benzodiazepines
145. Reason for increased MCV during aplastic crisis in patients with sickle -increased demand for folic acid
cell disease?
146. Reason for initial absence of murmur in some babies born with VSD? -increased pulmonary vascular resistance