NBME Exam Questions and Answers (Graded A) 25 yo F at 27 weeks w/ severe contractions x6 hours, vaginal spotting, contractions every 2-3 mins w/ FHR 130 and no decels, cervic 1-2 cm and 70% effaced, GBS is positive. next step? - Answer- IM beclamethasone THEN later can give penicillin man w/ 15 yr hx of difficult relaxing hands after tightly gripping objects or shaking hands, difficulty releasing after gripping w/ hands. dx? - Answer- myotonic muscular dystrophy pt unable to see out of R eye since awakening 2 hrs ago. visual acuity 20/200 in R eye and 20/20 in L. R pupil poorly reactive to light. where is site of lesion? - Answer- R optic nerve 6 mo old w/ poor feeding, labored breathing, to and fro murmur in 2nd L itnercostal space, loud S2, bounding peripheral pulses, widened pulse pressure. dx? - Answer- patent ductus arteriosus recurrent lymph node infxns w/ staph a in a kid. what is dx and mechanism? - Answer- chronic granulomatous dz --> impaired phagocytic oxidative metabolism pt hyperkalemic bc missed 2 dialysis appointments. EKG w/ peaked t waves. next step? - Answer- IV calcium gluconate --> THEN can give insulin but this works within minutes
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