Well here is what I remembered.

I’m not pretty sure about all answers; don’t assume that
they are all correct. Step2 is bit different paper in way that it demands your understanding
of principal of therapeutics not just facts. Anyway best of luck for your exam, I believe
there are enough clues on exam to nail it down. NBME is advice and pray for me!!

ME too ……..

1)Couple comes to office for infertility workup, they have been trying to conceive for
couple of year without success. Male 31 had Semen analysis normal. Female 28 had
irregular menses for 3 years. History is significant for D/C for leiomyoma uteri. What is
most likely cause of infertility:
a. Premature ovarian failure
b. Uterine synechae formation
c. Karyotype XO
2) Female 23 come for irregular menses for 3 months. Pregnancy test is –ve. Next
step in mg:
a. Estrogen progesterone challenge test
b. Uterine sampling
c. Mid cycle LH levels
d. Progestron Challenge Test
3) Female 21 come with fever, LLQ pain and Cervical motion tenderness. She have
IUD inserted 10 days age. Pregnancy test –ve. Other then antibiotic tx whatelse u wud
do:
Remove IUD no need to remove initially
4) Female 21 comes for regular health care exam. She is sexually active with 3 guys
in couple of years, she smokes cigarette regularly. Which contraceptive method shud be
avoided for her:
a. Barrier
b. Diaphragm
c. Sterilization
d. Birth Conrol pills
e. IUD
5) Women 60, postmenopausal with bleeding P/V. On physical exam she has BMI
34, BP 140/80. She have been taking metformin, glipizide, metoprolol and Ca
supplements. What is next BS in mg:
a. Endmetrial Sampling
b. DEXA
c. Advise wt loss
6) 22 female G2 P2 come in birthing unit with 4cm dilated and gush of blood and
clear fluid. She progressed to 8cm dilation, fetal head is well engaged. Fetal tracing show
repeated variable deceleration and Dec variability. Next best step
a. Fetal Scalp Electrode stimulation
b. Change mother position to left lateral initially resuscitate- then delivery
c. Begin tocolysis
d. Immediate C/S
7) Women 60, postmenopausal with bleeding P/V. On physical exam she has BMI
34, BP 140/80. She have been taking metformin, glipizide, metoprolol and Ca
supplements. End biopsy show Endometrial hyperplasia. What is cause of this
a. Hypersecretion of Estradiol by ovaries
b. Conv of Androstenedione to Estradiol in fat
c. Conv of Androstenedione to Estrione in fat
d. Hypersensitivity of Endometrium to Estradiol
8) 22 female G1P1 come with painful vaginal bleeding. Sono showed normal
position of placenta. Most likely cause
a. Placenta Previa
b. Abruptio placenta
c. Vasa Previa
9) 22 female G1P1 come with painless bleeding PV at 31 week. She is placed on
pelvic rest, given fluids and bleeding subsequently stops. Next step in mg:
a. Emergency C/S now
b. Bed rest & C/S at term
c. Vaginal delivery at term
10) Neonate with coughing and choking whenever feeding is attempted. Babygram
shown with tube tapering in esophagus. Cause
Transesophageal fistula, Chonal atresia, Vascular ring
11) 24 female G2 P2 at 24 week gestation. She is B- and FOB is A+. She received
Rhogam in previous pregnancy. Atypical Antibody test is –ve. Nest best step:
a. Rhogam Now
b. Kleiuhauer Bekte test rhogam after 4 wks
c. Amniocnetesis

12) 57 postmenopausal lady comes for regular health care exam. BMI 18, have family
history of osteoprosis. Best screening test
a. DEXA scan
b. Xray of wrist
c. Serum Ca/PO4
13) 8 Sickle cell boy with h/o Otitis media couple week ago. Now he has pain in
lower leg with tenderness, redness and hot. Temp 101F, ESR 60. Most likely organism
a. Staph Aureus
b. Salmonella Typhi
c. Strep Pneumo
14) Pt with hereditary spherocytosis have jaundice and anemia (hg 6). How cud this
be prevented: Splenectomy I guess Other options were weird genetic counseling was not
in choices
15) Sickle cell pt come to ER with bone pain. He is given Analgesics and O2. What
else to give:
a. Antibiotics
b. Exchange transfusion
c. IV Fluids
16) Sickle cell pt with Dec Hct (25) and Jaundice. What is etiology
a. RBC membrane Defect
 b. Hemolysis
c. Splenic Sequestration
17) Black female pt with UTI given TMP-SMX get jaundice and pallor of skin.
Mech XR??
a. Hemolysis
b. Ineffective erythropoises
18) 54 male comes for regular health care exam. His wife complain he got senile,
forget things, cant hold urine and Stumbles. CT shows Enlarged ventricles. Defect
a. Inc CSF production
b. Obstruction of flow of CSF
c. Dec CSF Absorption
19) 26 female comes with complain of headache. Opth exam show bilateral
papilledema. CT -ve Defect:
a. Brain tumor
b. Intracranial HTN
c. Migraine.
d. Cluster Headache.
20) 55 male come to ER with sudden blindness as if curtain falls on his left eye. Exam
show Lf Carotid Bruit. Duplex show 90% obstruction of common carotid. Next step
Endartrectomy, Observe
21) 44 female comes for regular health care exam. On exam she has thin parchment
like lesion of vulva, with atrophy of labia majora n minora. Biopsy show epithelial
thining. Cause
a. Normal finding
b. Pagets disease of vulva
c. Vulvar adenocarcinoma
d. Lichen sclerosis
22) Pt comes to ER with weakness of lower legs. Had flu couple weeks ago. Exam
show painful bandlike area in abdomen below which there is no sensation and weakness
of lower ext with Bibinski +ve. Cause
a. Spinal stenosis
b. Disc Herniation
c. Transverse Myelitis
d. Gullian Barre
23) Pt with smoking history of 40yrs comes with central mass on Xray. Biopsy show
keratin pearls. Lab show Ca 14. Cause
a. Inc OAF
b. Bone mets
c. Inc Parathyorid Hormone
d. Inc Parathyorid Hormone related peptide.
24) pt come to ER with electrical burn on Rt hand. Most susceptible organ
a. Hair
b. Bone
c. Heart
d. Eye
 25) Pt with overflow incontinence prescribe Bethanecol. Still have symptoms.
Best advice: Intermittent Catheterization
26) Sexually active pt with UTI. Advise to dec risk of getting UTI
Pee after having sex
a. 22 female G2
28) P2 24 wk come to checkup. Most likely Acid base disorder
a. Met Acidosis
b. Resp Alkalosis .
c. Met Alkalosis
b. Resp Acidosis
29) 60 male brought to ER by neighbors. He’s been living alone since her wife died
couple of year ago had disabling osteoarthritis eating tea toast diet. He is weak, pallor
with soft murmur 2/6 Lf lower sternal border. BP100/60 Pulse 110. Hg 6. MCV 110.
Most likely cause of anemia
a. Iron Deficiency
b. Vit C Deficiency
c. Folate Def
30) 23 male brought to ER after passing out for couple of mins, no preceding
symptoms. BP 110/70 Pulse 80 on lying and 105/65 pulse 84 on sitting. No prior h/o
passing out, heart leaping, convulsion or any medical disorder. On exam pt had syncope
on head turning also he feel dizzy while examiner press on his carotid. There was no
bruit. Cause
a. Carotid Stenosis
b. Vasovagal Syncope
c. Seizure
d. Carotid Hypersensitvity
e. Postural Hypotension
31) 24 female brought to physician bcoz of body aches. She is also been treated for
tension headache and depression. There are sensitive points which are tender to touch.
ESR 12. Dx
a. Firbromyalgia
b. Dermatomyositis
c. Polymyositis
d. Polymyalgia Rheumatica
32) 22 male brought to hospital for Rash. History is significant for Tx for sore throat
with Amoxicillin.There are morbilifrom rash all over the body including Conjuctival
Injecton. Cause amoxy rash after IM- after 24 hrs
look for IM features
Drug Hypersensitivity
33) Pt tx with Penicillin for sore throat had anaphylaxis, he had h/o previous episode
of “drug reaction” when given penicillin for sore throat previously. Best action
a. Decrease dose of penicillin
b. Replace Penicillin with Amoxicillin
c. Replace Penicillin with Erythromycin
d. Desensitize Pt for penicillin
34) Pt comes to ER with multiple trauma receive in high speed vehicle accident. He is
conscious, BP 110/70 Pulse 90 RR14. Chest is clear to auscultation with bilateral Breath
sounds, trachea centrally placed. Xray Chest and abdomen is –ve. Pupil are normal and
reactive to light, there is swelling and redness behind ear and blood behind tympanic
membrane on otoscopic exam. He is at Inc risk of
a. Brain herniation
b. Compartment syndrome
c. Meningitis
35) Pt with osteomyelitis of foot Tx with Dicloxacillin. No response after couple of
week of therapy. Alternative
a. Ceftriaxone
b. Erythromycin
c. Vancomycin
d. Aztreonam
36) Diabetic Pt with foot Osteomyelitis. Culture grow Staph which factor is important
for longterm chance of recovery:
a. Improved Glycemic Control
b. Blood Supply to limb main factor for healing- vascular supply
37) Couple of Question of Osteoarthritis of knee in Obese Women. Other then wt loss
what else non pharm intervention will improve quality of life
Strengthening periarticular muscles
37) Diab pt with Uncontrolled Blood glucose on metformin and glipizide. He take
thiazide for HTN. What is cause of poor glycemic control: Dec Senisitivity of
Insulin/Dec Production. thiazide le dec production
38) Pregnant women with poor glycemic control. Which complication she might
have
a. Preterm labor
b. Oligohydramnios
c. Birth Defects
d. Small for Gestational Age
39) Female G2P2A0 come for prenatal visit on 28 week gestation. On exam her
fundal hight is 24cm. Next step confirm IUGR by sono
Sono/NST/CST/Immediate C.Section
40) Newborn born to G1P1 23 female with no prenatal care. Apgar 5 and 6 at 1 and 5
mins. Successful resuscitated, RR150 BP 110/60 Acrocyanosis. No Murmur/Gallops, gas
sounds in Lf hemithorax. What associated complication is Most likely:
a. Sepsis
b. Pulmonary Hypoplasia
c. Caudal regression
d. Duodenal Atresia
41) 2 year old girl passes out while crying too hard. It is brought about by anger,
similar episode of attack she she holds her breath, her face becomes purple and her
tongue looks purple afterward she will be sleepy. Dx
Breath Holding spell
42) 8 yr old child with disproportionality b/w upper and lower body. His trunk and
upper extremities well develop as compare to lower. On exam BP 150/80 in Rt and
120/60 in Lft. There is delay in radial : femoral. Cause
Coarctation of Aorta
43) Pregnant G2P2 at 33wk gestation. Diabetic women with respiratory difficulty.
Normal physical exam. Chest Xray normal. ECG normal and ABGs PO2 94 PCO2 34
PH 7.44 HCO3 20 Probable cause
Polyhydramnios, Heart Failure, Pulmonary Embolism, Pleural Effusion.
44) Neonate born to diabetes mother brought to NICU for convulsions. Most likely
cause
a. Hyponatremia
b. Hypernatremia
c. Hypoglycemia
d. Hyperglycemia
45) 26 Female G1P1 at 28 wk gestation come with mild bleeding after intercourse.
She smokes and drinks, she is monogamous with her boyfriend at this time but she had
couple of boyfriends in past years. She has not seen doctor for 16 yrs. On exam there is
friable bleeding lesion on Os(Closed, Posterior). ML Cause
os closed- on previa; may be cervicitis?
Cervical Cancer
46) 22 male come to ER for breathlessness. He is IVDA tested +ve for HIV received
no care. There are multiple needle marks on cubital fossa, BP 110/70 Temp 101F RR 24.
On exam there are bilateral harsh breath sound with no egophony or v. fermitus. Xray
show Interstitial infiltrate bilaterally. Rest exam normal. Most likely org:
a. Staph Aureus
b. Staph Epidermidis
c. Pneumocystis Jiroveci
d. Strep Pneumo
e. Mycoplasma

47) 22 male with severe crohn disease get extensive bowel resection. Lab Hg 8 MCV
70. Most likely cause of anemia
a. Anemia of chronic disease
b. Iron Deficiency Anemia
c. Folate Deficiency Anemia
48) 34 male brought to ER with tearing chest pain rate 9 on scale of 10. On exam BP
190/100 RR 22 Temp 98 Pulse 102. Next step in mg
Lower BP
49) 22 male come to physician with dec sensations. He had multiple burns and cuts on
his hands bcoz he don’t feel them happening. Power 5/5, Reflex 3/5 normal sensation to
vibration, touch but Dec sensation for pain and temp in upper and 5/5, Reflex 3/5, normal
sensation to touch, vibration, pain and temp in lower extremity. Cause
a. Reflex Sympathetic dystrophy
b. Central cord syndrome
c. Syringomyelia
d. Peripheral Neuropathy
50) couple bring there newly adopted 4 yr child from Kenya, the child limp when he
walks. Power 1/5, Reflex 1/5, Flexor plantar response in right Lower while Power 5/5
Reflex 3/5, Bibinski –ve in Lf Lower extremity. ML cause
a. Inborn Error of Metabolism
b. Viral Infection polio..
c. Caviation of Cervical cord
d. Disuse atrophy
51) 30 female involve in high speed MV Collision brought to ER with feeble pulse
and BP 80/50. Breath sound normal bilaterally, No Neck vein distention. Xray show
broken 1st rib. ML cause
a. Pneumothorax
b. Transection of Aorta
c. Pericardial Temponade
52) 30 female involve in high speed MV Collision brough to ER with multiple
injuries. On exam there was no breath sound on Rt Resonant Percussion and shifting of
trache to Lft. There are multiple contusion on chest n abdomen with crumbling sound on
palpation of neck n thorax. Chest Tube inserted to Rt and other injuries taken care of.
There is little drainage from tube but lot of air and Rt lung remain collapse. Cause
a. Traumatic Esophageal Perforation
b. Tension Pneumothorax
c. Bronchial rupture
d. Flail Chest
e. Respiratory Distress syndrome
53) 25 male alcoholic brought to ER with Vomiting and Retching after having night
binge drinking. On exam BP 100/60 Pulse 112 RR 21 Temp 98.6. Amylase 80 Lipase 5.
Xray chest show rt sided pleural effusion. ML Cause
Mallory Wiese Tear, Esophageal Rupture, Pancreatitis, Lobar Pneumonia
54) 55 male admitted for Pneumonia 6 days ago and tx with antibiotic still have
spiking chills and fever. Lateral Decubitis Chest Xray show Rt side Effusion.
Thoracocentesis show PH 7.1 LDH 240 Glucose 40 mg/dl. Next step
Chest tube insertion (its empyema)
55) 32 Homosexual male with known HIV for 6month present for regular checkup.
His drugs include Zidovudine, Ritonavir, Limuvidine, Bactrim (TMP/SMX). Lab show
March April May
CD4 300 200 50
Viral Load 50000 75000 90000
Next Best Step in Mg:
a. Regular follow up in 1 month
b. Pneumocystis Jiroveci prophylaxis
c. Repeat CD4 count in 1 week
d. Change HRT resistance testing is nex

It is Tx failure
56) Newborn born at 38wk to 22 female G1P1 receive no prenatal care found to have
rash over body, machinery like murmur and systolic murmur on Rt sternal border. ML
cause
a. Prematurity
b. Toxoplasma Infection
c. Chromosomal Aneuploidy
d. Maternal Rubella
57) 24 female nurse is seen by physician for fatigue. On exam there is lacy symmetric
rash of face and upper arm and congestion of throat. Rest of exam normal. BP 110-80
Pulse 20 Temp 99.
Hgb 10
MCV 90
WBC 2000/mm3
Platelets 50000
ML Cause:
a. Disseminated TB
b. Idiopathic Thromocytopenic Purpura
c. Congenital Hereditary Spherocytosis
d. Parvovirus Infection
e. Hypersplenism
58) 23 G2P2 at 38 gestation brought in labor with 3cm dilated cervix, water broke and
she had regular contraction every 3mins. Last visit was 12 wk Gestation. She complains
of painful itchiness in vagina, exam show vesicles in vagina. Best Mg:
Tocolysis, C/S, Vaginal Delivery,
59) 22 G1P1 at 22 wk gest with vaginal pain and itching. Exam show multiple
vesicles. She is sexually active with her husband. Best course of action at this time:
Avoid Intercourse, Sono, NST, Advise C-Section at 34wk, C –Section at term
60) Case of episodes of temporal lobe epilepsy after trauma. Asked for tx:
Carbamzepam, Lorazepam, Haloperidol, Fluoxetine.
61) 23 male refer to physician by employee bcoz of change in behavior. For past 2
weeks he have been working 16 hours for multiple projects and talk about undoubtful
success. He seem to be Fidgety, has flight of ideas and pressure speech. He accept that he
have spend thousands of dollar for his new idea. Tx:
Methylphenidate, Lithium, Fluoxetine, Alprazolam.
62) Pt with depression. What change u expect in sleep
a. Inc REM Latency
b. No Delta wave
c. Dec REM Latency
63) Pt dx with Schizophrenia tx with Antipsychotic come for follow up exam. He
describes feeling fidgety, anxious, have insomnia and anger. Which Neurotransmitter is
involve:
a. Dopamine
b. Nor epinephrine
c. Seretonin symptom ko matra kura garya hola....
d. Histamine
e. Acetylcholine
64) 66 female come to physician for abnormal involuntary movement limbs and
smacking of lips and face. She has HTN, Osteoarthritis, CHD and GERD tx with
Metazolone, Metoclopramide Amlodipine, Calcium, Alendronate, Simvastatin and
Acetaminophin. Cause
a. Dec Dopamine in nigral pathway.
b. Absence of Acetylcholine in Myenert Nuclei
c. Chronic Inhibition of Dopamine
d. Increase Dopamine Activity
65) 25 male known Down syndrome working in shelter home come for habit of
repeated hand washing 60 times a day. Tx
a. Diazepam
b. Haloperidol
c. Selegline
d. Clomipramine
e. Buspiron
66) 22 male pass out while in bar room with her girlfriend brought to ER. On exam he
looks normal Pt confirms that he started dated this girl recently and she insist her to go
out and have fun as he avoid going outside with his friends as well. ML Disorder
a. Panic Attack panic attack chai vayena jasto lagyo
b. Social Phobia
c. Shizoid Personality Disorder
d. Shizotypal PD.
67) Case of Schizoaffective Disorder
68) 8 Male Child get breathless when he is playing with peers in school. He feel chest
tightness difficulty and blown up. Dx
Asthma
69) similar q ask which test to offer: PFT (probably with methacholine challenge if
req)
70) 24 female come to physician for b/l clear discharge from nipple and no menses for
past 6 months. She is monogamous with her boyfriend. Pregnancy test –v. Prolactin 100
ng/ml TSH 4. Tx
Propylthiouracil, Clomiphene, Bromocriptine, Selegline, Levothyroxil.
71) 28 Black male pt come to physician for breathlessness and easy fatiguability. He
doesn’t smoke, exercise regularly but for past 3 month he get short of breath while
running for couple of blocks. Xray show reticular pattern and B/L Hilar
lymphadenopathy. What u will find on PFT
a. Dec FEV/FVC Ratio
b. Inc Vital Capacity
c. Inc expiratory Reserve volume
d. Dec Diffusion cap of CO
72) 22 male brought to ER with Chest pain. On Exam BP110/70 RR 24 Temp 98
Pulse 120. He doesn’t smoke; have no family h/o Heart disease. He describes numbness
around mouth and tingling of fingers. ECG shows sinus tachycardia. Next Step
Reassurance
73) 55 male come to physician with pain brought on walking relieve by sitting and
leaning forward. Dx
Spinal Stenosis
74) 44 male come to physician with abdominal pain for 6 month. Diffuse brought on
by eating; he lost 12 kg during period. He has h/o smoking (25yr), HTN and Gout. He
denies drinking beer. Most likely cause
Peptic Ulcer Disease, Mesentric ischemia, Pancreatitis, Crohns.
75) 56 male brought to ER bcoz of disorientation for 2 days. Sono show B/L enlarge
kidneys and dilated pelvis and distorted thin calyces. Labs show
BUN 70
Creatinine 4.2
Most Likely cause
Benign Prostatic Hyperplasia
76) 8 girl brought to physician bcoz of swollen eyelid and red urine. She had sore
throat couple of weeks b4 that resolve on its own. BP 160/86 Temp 99 RR 18. Etiology
a. Release of Histamine
b. Antibody against Basement Membrane
c. Effacement of Foot process
d. Arteriolar thickening of afferent arterioles
e. Antigen-Antibody Complex Deposition
77) 33 male tx for pneumonia come to ER with diarrhea. Tx Metronidazole
78) 70 male comes to regular health care exam. Exam BP 140/70 Pulse 80 rest exam
normal. Family complain that he listen TV loudly disturbing other family members.
Cause
Presbycusis
79) 74 female come to ER with Left Lower Quadrant abdominal pain. Stool Guaic
+ve. Tenderness to palp, Tmp 101F BP 110/70. ML Cause
a. Appendicitis
b. Ovarian Torsion
c. Diverticulitis
d. Ischemic Colitis
e. Angiodysplasia
80) 67 male with lower GI bleeding. Imaging show vascular lesion in asceding
colon. Dx Angiodysplasia
81) 8 brought by parent bcoz she start menses too early while her sister started
menses at age 12. On exam her breast are firm with enlarge areola and separation of
contours. There are coarse and curly axillary and pubic hairs extending to thighs. On
exam is complex Lft adnexal mass 3x4 cm. BHCG –ve. What is Dx
a. Normal for her Age
b. Mc-cune Albright Syndrome
c. XO Syndrome
d. Granulosa Theca Tumor
82) 22 Male of Ashkenazi Jewish descent present with perianal discomfirt. On
exam there are opening lateral to anus cord like tract leading deep in Ischiorectal fossa.
There is RLQ palpable mass on abd exam. He denies Homosexual but accept of diarrheal
illness since 16. Dx
Crohns, Ulcerative Collitis, Squamous Cell Ca of Anus, Whipple Disease
83) 44 female present with swollen belly. There is +ve Fluid wave and shifting
dullness. Abdominal tap reveal milky white fluid. ML cause
a. Pancreatitis
b. Bile peritonitis
c. Lymphatic Obstruction
d. Portal Hypertension
e. Carcinomatosis
 84) 7 Child is brought to pediatrician for visual problem. He is 3 Percentile for his
Height and 40 Percentile for his weight. Visual field exam show dec temporal vision
bilaterally. CT show suprasellar Calcification. Dx
Craniopharyngioma, Pilocystic astocytoma, Ependymoma, Pitutary Adenoma
85) 32 male tx for single duodenal ulcer seen on endoscopy 4 weeks ago with
Omeprazole come for followup. He feel better and have fewer pain. Endoscopy reveal
ulcer unchanged from pervious visit. ML Cause
a. Zollinger Ellison Syndrome
b. Adenocarcinoma
c. H. Pylori Infection
d. Crohn Disease
86) 22 female present with yellowness of eyes. On exam there is scleral icterus, no
pallor of palpebral conjuctiva, Mucous membrane. BP 110/70 RR 18 pulse 78 Temp
100F. On Exam liver is enlarged 3cm below costal margin and tender to palpation. Rest
of exam is normal. ML Cause
a. Hepatic Abscess.
b. Cholangitis
c. Hereditary spherocytosis
d. Hepatitis
e. Hepatic Adenoma
87) 32 female with symmetric arthritis of wrist, MCP and PIP joint come to you with
bilateral red, hot, swollen knees there is discomfort of motion and fluid wave +ve.
Arthroscopy will show
a. Calcinosis of articular cartilage
b. Destruction of synovium with tissue inflammation
c. Destruction of articular cartilage with bony spurs
d. Boggy and inflamed snyovium
88) 28 female come to physician for joint pains and fatigue for 3 months. There is
bilateral symmetric arthritis of hand and knee joint. LAB shows
Hgb 8
WBC 8K
Platelets 80000/mm3
RA +ve
ANA +Ve
Ca 8
Na 140
K 4
Cl 106
BUN 40
Creatinine 3.2
ESR 80
ML Dx:
a. Polymalgia Rheumatica
b. Polymyositis
c. Rehumatoid Arthritis
d. Systemic Lupus Erythematosis
e. Polyarteritis Nodosa
89) 42 male brought to ER with severe unilateral headache and pain behind Rt eye. It
started 1 hr ago and peak in 15 mins. He had similar episodes pains before 1 year ago
which remain for 2 week and resolve spontaneously. He has Rt Conjucival injection,
lacrimation and rhinorhea. Pupil is reactive to light. Cause
a. Migraine
b. Tension Headache
c. Angle closure glaucoma
d. Cluster Headache
90) 45 female k/c of migraine comes for regular checkup. She had BP 150/96 on
multiple readings in past and no change with health style modification for 3 months. Best
Drug to prescribe
a. Thiazide
b. Propanolol
c. Captopril
d. Trazosin
91) Diabetic pt with HTN. Drug to prescribe: ACE
92) 32 male pt come to physician for wt loss for 3 months. He has lost 20 lb,
complains of night sweats and evening temperature. There are cervical occipital and
inguinal lymph nodes palpable. Dx
Hodgkin lymphoma, ALL, CLL, CML, AML
93) Case of Phenytoin induce lymphadenopathy.
94) 65 male present with fatigue. Smear shown atypical lymphocyte and smudge
cells. WBC 50,000/mm3. Dx CLL
95) Case of anemia and wt loss in 55 male. Cytogenic analysis show translocation of
9:22 chromosome. Dx CML
96) Cases on Shock (very High yield for boards)
Cardiac Index PCWP PVR
↓ ↑ ↑ Cardiac Shock
97) ↓ ↓ ↑ Hypovolemic Shock
98) Young pt with HTN and Abdominal Bruit= Renal Artery Stenosis
99) Case of RAS Ask what change in
Renin Aldosterone NorEpinephrine
↑ ↑ No Effect(I guess)
All Possible choices give
100) 45 smoker with multiple hospitalization for dyspnea and pulm infection come to
ER with severe breathlessness and Dec O2 Sat. He is given 100% O2. ABGs show PO2
50 PCO2 90. Next best step COPD
a. Inc O2 conc
b. Hyperventilate patient
c. Dec O2 conc
d. Respiratory stimulant (theophyline)
e. Salbutamol inhalation
U knock out his respiratory drive.
101) Similar case of acute exacerbation of COPD land into ED but lab changed ABGs
show PO2 55 PCO2 50 O2 sat 85%. Next best step: Give O2 (low Conc Offcoruse)
102. 5 Child with multiple UTIs having VU Reflux. Mg: Give prophylactic Antibiotic
103. 32 female come to ED with Fever, Lumbar tenderness and dysuria. Urine D/R
show +ve Nitrites +ve Estrases multiple WBC and bacteria. Tx with Levofloxacin I/V. 3
days letter feels better with good urine outuput. Culture grow Ecoli sensitive to
Levofloxacin, TMP/SMX, Ceftriaxone, meropenem. Next best step
Stop I/V Levo start Oral TMP/SMX
104. Couple of Anatomy Questions
105. 8 boy from poor community present with greenish pale complexion of skin. He
have pallor of mucosa and conjunctiva. Hgb 8 MCV 70. How cud this has been
prevented:
Wearing Shoes while playing in dirt (Its hookworm)
106. 32 female present to ER with heart leaping. What does she have?

a. Atrial Fibrillation
b. Atrial Flutter
c. Supraventrical Tachy
d. V Fib
107. 28 male comes to ER with Chest pain. Worst by lying down relieve by leaning
forward. He had flu a week ago resolve spontaneously. BP 114/76, Temp 100.2F RR 18
Pulse 88. ECG Shown. Best next step (couple on same case in fact)
 a) Ibrupofen
b) prendnisolone
c) Alteplase Infusion
d) Angioplasty
108) 29 male come to physician for Rt upper quadrant discomfort. He doesn’t smoke,
monogamous but drink 10 beer daily. BMI 28. BP 114/76, Temp 98.2.2F RR 18 Pulse
88. Lab show
Hgb 12
MCV 87
WBC 8000/mm3
Platelets 320000/mm3
AST 400
ALT 250
Bilrubin Total 1.5
Direct .8
Cause of Pt pathology:
a. Hepatitis
b. Alcohlic steatosis
c. Acute Cholecystitis
d. Cholangitis
89) 43 male come to physician for yellowness of eyes. He has no h/o IVDA, Sexual
promiscuity, Blood transfusion. Vaccination upto date. Exercise regularly and had last
visit year ago when BMI was 22. On Exam there is yellowness of eyes and mucous
membrane. No clubbing, Chest is clear, S1S2 audible with no murmur/gallop. There is
non tender mass on deep palpation in epigastrium. BP 114/76, Temp 98F RR 18 Pulse 88
BMI 18. Cause
a. Gastric Carcinoma
b. Choledocal Cyst
c. Pnacreatitis
d. Pancreatic Adenocarcinoma
e. Reidel Lobe
90) 22 male come to physician for itchy rash over body. On exam there are scaly
raised rash parallel to langerhan lines of trunk and back. Rash was preceded by single
scaly lesion. No H/o similar rash b4. Dx
a. Atopic Eczema
b. Tinea Versicolor
c. Pityriasis Rosea
d. Contact Dermatitis
e. Lichen planus
91) Case of Jock Itch (Tinea Cruris)
92) Case of Carbuncle of skin (pustular lesion on skin in diabetic male)
93) 4 boy brought to physician by parent bcoz he doesn’t speak well. Utter mumbles,
prefers to play by himself and same toys. Doesn’t play with siblings, fail to attach to
parents and outburst anger when disturb. Dx:
a. Attention Deficit Hyperactive Disorder
b. Mental retardation
c. Fragile X Syndrome
d. Pervasive Learning Disorder
e. Rett Disorder
94) 6 child brought to physician by parent bcoz he still wet his bed. He have problem
with holding urine both during day and night. Reward system not helping. Sono is
normal. Urine analysis show
WBC 1-2/Hf
RBC None
Cast None
Estrase -ve
Nitrite -ve
Glucose 400mg/dl
Protein 2+
Ketenes -ve
What is Dx:
a. Enuresis
b. Urinary Tract Infection
c. Low lying ureter
d. Diabetes Mellitus
e. Glomerulonephritis
95) Case of normal 14 yr adolescent. Mom concerned as he don’t sit with them, use to
play video games for hour, chat with her girlfriend, doesn’t enjoy family gathering.
Reassure Parents
96) Another Case of adolescent where u had to do anticipatory counseling about
hazards of Drinking and driving.
97) 23 female brought to ER confused and disoriented by her family. She had
meningitis tx successfully 3 weeks ago with Antibiotics. On exam she have dry mucous
membrane, tented papery skin and no tearfilm. Family told that she crave for ice water
and urinate lot more then usual. Urine tonicity 1.005 Osmol 150 Neg for WBC, Cast,
Protein, Estrases. Serum Osmolarity 380. Cause
a. Nephrogenic DI
b. Diabetes Mellitus
c. UTI
d. Water Intoxication
e. Central DI
98) Case of Lung mass in heavy smoker with urine osmolarity 450 and serum osmol
240. Na 128 Cl 105 K 4 . Next best step
a. Water Restriction
b. 5%Dextrose in half normal saline
c. 3% saline infusion
99) Post operative (open Cholecystectomy) 32 female pt with fever on Day 2. She is
not amulatory. PO2 80 PCO2 50 Xray shown having Rt lower lobe collapse. Dx
Atelectasis
100) Post Chemo pt with WBC 1000 35% neutros 45% lymphos have BP 110/70 Temp
101.2F (38C). Best Next step
Admit and give Ceftazidime
101) 2yr boy present with Curdy milky material covering touch and oral cavity. It can
be scraped off with tounge blade. H/o Viral Encephalitis when he was 8months and Tx
for pneumonia 2 months ago. What is Defect
a. Transient Hypogammaglobinemia of Infancy
b. Bruton’s Hypogammaglobinemia
c. Degiorge
d. Subacute Commined Immunodeficiency
e. Job Syndrome
102. 12 month boy with multiple Otitis media since 6 month. Cause
Butons Hypogammaglobinemia vs IgA- age
103. Pt involve in MVA brought to ER. He has Papilledema. Best fastest way to
Reduce ICP: I choose Hyperventilation over Mannitol.
104. Case of Hemmorhagic Disease of Newborn (Vit K Deficiency)
105. 45 male brought to ER bcoz of vomiting, headache and them obtundation. CT
show IC Hemorrhage. BP 170/110. How cud this been prevented
a. Low salt Diet
b. Aspirin
c. Carotid Duplex
106. Pt shot in thigh by .38caliber revolver in Rt thigh 3inch lateral to femoral pulses
(intact). Popliteal, Dorsalis pedis and Post Tibial all palpable. Normal Sensory motor
exam of limb, no bleeding from site. Best step
Waitful Watching no hard soft signs
107. 8 child comes to physician with complain of pain on movement in both knees.
He had Erythema Migrans on exam. Dx Lyme Disease
108. 26 female come to physician for complain of difficulty sleeping. She describe
burning, tingling sensation in feet as she go to bed relieve by rubbing and hot water
emersion. She also has Iron def Anemia. Dx
Restless Leg Syndrome (in fact had couple of cases on this one)
 109) 32 female with bloody discharge from nipple. No mass palpated on physical
exam. Mammography reveal no clue. Dx : Intraductal Papilloma (Glactogram is
investigation of choice)
110) 22 female come to physician with breast mass. On exam 2x2 rubbery, freely
movable, non tender, well circumscribed mass found in rt breast. No relationship to
menses. Dx Fibroadenoma
111) 33 female come with weight gain and fatigue for 3 months. She gain 20lb
weight, have constipation, intolerance to cold weather, delayed relaxation phase deep
tendon reflex and fatigue. Thyroid Gland firmly enlarge nontender. TSH 8. Etiology
a) Granulomatous inflammation of Thyroid Gland
b) Fibrosis of T gland
c) Autoimmune distruction of T gland
112) 5male 4 with painful bullous lesion on trunk and extremities that burst easily.
There are oral ulceration and skin peel off easily by gentle pressing. Dx Pemphigius
Vulgaris
113) 32 female come to physician complain of sweating and confusion relieve by
taking snack. She avoids going outside bcoz of episodes and her husband think that she
try to catch attention. During interview she starts sweating profusely, palpitation,
confusion and numb body. Juice relieves her symptoms. Lab show Glucose 50 mg/dl and
Insulin level ↑ C-peptide ↑. Cause
a. Insulinoma
b. Suppertitious Insulin Injection
c. Functional Problem
d. Pheochromocytoma
114) 26 male present to ER with palpitations, racing heart and headache. On Exam
BP 170/110 Pulse 140 RR 22 Temp 98F. Glucose is 220mg/dl. Most likely cause
DM, Pheochromocytoma
115) 25 G2P2 female come to physician1month after delivery of 9lb boy at 38wk
Gestation complicated by Postpartum Hemorrhage with complain of failure to lactate.
Defect
a) ↓ production of prolactin from Hypothalamus
b) ↓ Production of Prolactin from Ant Pitutary
116) 28 female Pt with Crohn disease well controlled with steroid undergo surgery
for fibroids. On postoperative day 2 she feels disoriented. BP 90/70 Temp 100F Pulse 70
RR 22. Lab Show
Na 128
Cl 100
K 5
HCO3 15
Most likely cause:
Sepsis, Adrenal Failure, Internal Bleeding.
117) 23 G1P1 female tested for syphilis on first prenatal visit at 12wk gestation. RPR
+ve. FT-ABS –Ve. Physician inform that PRP was false +ve. Based on fact that:
a) RPR have high specificity low sensitivity
b) FT-ABS lack both sensitivity and specificity
c) RPR have high False –ve Rate
 d) RPR have high sensitivity while FT-ABS have high specificity
118) 22 male believe that he have Colon cancer. His father had Colon Ca. He had
multiple colonoscopies, Barium enemas and regular Stool for occult blood all run –ve. He
had diarrhea last week which he think is sign of early cancer and request repeat
colonoscopy as it might miss 3month ago. Dx
Hypochondriac
119) Case of borderline women with suicide attempts
120) Case of Primary syphilis Chancre (painless, lesion on penis with rolled edges)
describe.
121) 32 female with strong family h/o Breast Ca. She wants to be evaluated for Risk
of Ovarian Cancer which test might help
BRCA1 (not BRCA2)
122) Female with Major Depression tx with Fluoxetine and alprzolam (for
insomnia). Her symptoms not well controlled Nefazodone is added to regimen. She is
found stuprous in her room. Only respond to pain with eye opening. NBS in mg:
Check Level of Alprazolam/ Fluoxetine/ Nefazodone respi depression??
123) 42 female with h/o osteoarthritis present to ER sever Rt upper quadrant pain. Her
med include acetaminophen. On exam BMI 28. BP 114/76, Temp 98.2.2F RR 18 Pulse
88, rt upper quadrant tenderness. Lab
Hgb 12
MCV 85
WBC 8000/mm3
AST 1000
ALT 800
T. Bilrubin 1.6
Indirect .8
HBsag +ve
Anti HBsag -ve
HAV IgM -ve
HEV IgM -ve
HCV IgG -ve
Cause:
a) Hepatitis
b) Acetaminophin toxicity
c) Fatty Liver
d) Cholecystitis
124) Case of 28 male with back pain, he lifted heavy wt while shifting home.
Tenderness to palpation of Para spinal muscle and leg raise give pain. No saddle
anesthesia, Incontinence. Tx
Bed Rest and analgesics
125) Case of Toxic Transverse colon.
126) Pt brought to ER after drowning in under Ice Lake for 20 mins. While CPR is
ongoing he had seizure. What cud be electrolyte disorder hypoxia le garda hola
Hyponatremia
127) 26 female with hematuria and hemoptysis. Dx Goodpasture
128) Family going trip to long island concerned about lyme disease. Best advise
Wear long sleeve shirt and full trouser DEET laune- most effective
129) 6 boy pass out while playing with neighbor kids. There is family history of
sudden death of maternal uncle. Next step
EEG, CT brain, ECG, Carotid Doppler, Angiography.
130) Case of Fat emboli after traumatic fracture of long bone in young female
131) Sono showed liver mass in female. CT done showing mass 3x 4 irregular border
consistency and radiation. ML cause
a. Hemangioma
b. Hepatic Cyst
c. Hepatoma
d. Hepatic adenoma
e. Hemartoma irregular - cancer hola
f. Hepatocellular carcinoma
132) 23 diabetic male come to physician with perianal discomfort and pain. On rectal
exam there is hot,tender swelling in IR fossa. Tx Incision and AB
133) 36 male with Wound infection and toxic look. Best mg: Extensive Debridement
of Wound
134) IVDA got Endocarditis involving all four valves. ML organism
Stap Aureus
135) 12 male is brought to physician by parent bcoz of fever and getting breathless too
quickly. He had sore throat tx 3 weeks ago. On exam there is Diastolic murmur at apex
and Gallop. Chest auscultation reveals crackles. There is swelling and discomfort of knee
joints. . BP 114/76, Temp 100F RR 18 Pulse 88. What is longterm mg for pt
Oral penicillin V
136) 23 female tx for UTI developed rash while surfing on beach. Again she present
with UTI, she want to avoid that problem again. Which drug to avoid:
Ciprofloxacin, Tetracycline, TMP/SMX, Amoxicillin
137) 26 female avid beach lover come to physician with 2cmx 1.5cm irregular,
asymmetric, Blackish raised lesion on torso. Next step
Watchful Waiting, Punch Biopsy, Excision and biopsy
138) 50 male brought to physician by wife bcoz he seem slow for long time. On
exam there is rigidity, drooling of saliva, fix emotionless face, bradykinesia, tremor at
rest. Defect : Degeneration of Substansial Dopaminergic neurons
139) Couple of cases on Huntington chorea
140) Newborn with cyanosis. Initial Mg: Alpaprostadil (PGE1 Analog) to keep
ductus open ( no further option looked appropriate)
141) Couple of Questions on Interpretation of ABGs.
142) Couple of study Designs ( Know P value and what is signifies)
143) Also on pearson Correlation (-0.8 is stronger correlation then +0.68)
144) Pt started on Antipsychotic become mute, rigid and have high fever. Mg:
Give Dantrolene (Off course discontinue med that cause it)
145) 23 female pt fear cats. She started dating a man with pet cat in house. She likes
to date him but fear of cat in house. Tx
Behavioral Therapy
146) 23 female have elective cholecystectomy tomorrow. Her mother had high temp
and rigidity during operation. What is greatest risk of surgery
Malignant Hyperthermia genetically acquired