RV Firecracker NBME / Practice Qs

Question 1

What is the primary treatment for acute cellular rejection (of transplant)?

Answer 1

Corticosteroids

Question 2

Which agent reverses heparin?

Answer 2

Protamine sulfate

Question 3

What is the classic skin appearance of arterial insufficiency?

Answer 3

Shiny, hairless

if ulcers: distal (furthest away from blood)

Question 4

What are the diagnostic criteria of ARDS?

Answer 4

Respiratory symptoms develop within one week of a known clinical insult.

Bilateral opacities consistent with pulmonary edema are present on imaging.

Cardiac failure is excluded via an objective measurement (e.g. echocardiogram).

A moderate to severe impairment of oxygenation is present, defined by the ratio of arterial oxygen tension to fraction of inspired oxygen (PaO2/FiO2).

(Berlin definition)

Question 5

How do pt with ARDS present?

Answer 5

diffuse bilateral opacities consistent with pulmonary edema, minimal improvement with oxygen therapy, and a physical exam that is not consistent with heart failure

Question 6

What is the mechanism of ARDS after trauma?

Answer 6

Pulmonary contusion

Question 7

How long are pt usually immobilized before PE 2y to DVT?

Answer 7

3d or more (eg after recent surgery)

Question 8

What is the management of postop ileus?

Answer 8

Supportive:
bowel rest, maintenance intravenous fluids, early ambulation, electrolyte replacement, serial abdominal examinations, and minimal opioid administration
NG if N/V/abdo distension

Question 9

What is the most common cause of overt lower GI bleeding? How does it present?

Answer 9

Diverticulosis

Presents with painless, often large-volume, hematochezia

(Colon cancer presents with occult bleeding)

Question 10

How can fibroadenoma be distinguished from fibrocystic changes on exam?

Answer 10

Fibroadenoma: solitary lump
Fibrocystic: often bilateral. Often pain/lumpiness increase just prior to menstruation

Question 11

What is the ABCDE mnemonic for skin lesions?

Answer 11

Asymmetry
Border
Colour
Diameter
Evolution

Question 12

What kind of biospy should be done to assess ?melanoma?

Answer 12

Excisional, with 1-2cm margin

Question 13

What is the most likely cause of intermittent, painless bleeding in children under 2y?

Answer 13

Meckel’s diverticulum

Question 14

What does Tc-99m pertechnetate scan assess?

Answer 14

Taken up by gastric mucosa

Used to assess for Meckel’s (with heterotopic gastric tissue)

Question 15

What is a cholesteatoma?

Answer 15

destructive and expanding mass of keratinizing squamous epithelium within the middle ear

Question 16

How do cholesteatomas present? What is the treatment?

Answer 16

chronic otorrhea, ear fullness, and unilateral conductive hearing loss

can be congenital or occur following an episode of otitis media that causes rupture or retraction of the tympanic membrane

Tx: surgical resection

Question 17

What imaging test is currently not routinely used in assessment of breast cancer? Why not?

Answer 17

MRI

very sensitive and can identify breast cancers that are not detected by mammography or ultrasound. However, it has a low specificity which leads to unnecessary biopsies, delays in treatment, and increased mastectomies.

Question 18

What should you suspect in a pt with a “sunburst” pattern in a bone mass?

Answer 18

Osteosarcoma

Question 19

Clinically, how does an epidural hematoma present?

Answer 19

Trauma to head, brief loss of consciousness, lucid interval lasting up to several hours, then herniation (notably with CN3 palsy)

Question 20

What does a CN3 palsy look like?

Answer 20

“down and out” gaze with fixed pupil