Cardio
Personality disord
Heme/onc
Nerve roots/arteries
Randotron
100
Anterior infarct: STEMI in what leads?
V1, V2, V3, V4
100
This personality disorder is characterized by a lifelong pattern of voluntary social withdrawal, emotional coldness, and flattened affect. These patients often prefer to be alone and do not desire close relationships.
🟩 What is schizoid personality disorder?
100
This is the most common cause of microcytic anemia worldwide and often presents with low MCV, low serum ferritin, and high TIBC.
🟩 What is iron deficiency anemia?
100
This deep tendon reflex corresponds to the S1 nerve root and is diminished in patients with herniation of the L5-S1 disc.
🟩 What is the Achilles tendon reflex?
100
In a patient with suspected bacterial meningitis, you must give this treatment immediately if there are signs of increased intracranial pressure (e.g., papilledema, altered mental status) and you are planning a head CT before LP.
🟩 What is empiric antibiotics and dexamethasone before the CT and LP?
🔥 NBME trap: Delaying antibiotics for imaging → increased mortality. LP can wait, abx can't.
200
First degree AV block
200
This cluster A personality disorder is associated with odd beliefs, magical thinking, social anxiety, and eccentric behavior. Patients may have ideas of reference but typically lack full-blown psychosis.
🟩 What is schizotypal personality disorder?
200
A hospitalized patient develops sudden-onset bleeding from IV sites. Labs show: ↓ platelets, ↑ PT, ↑ aPTT, ↓ fibrinogen, and ↑ D-dimer. This is the most likely diagnosis.
🟩 What is disseminated intravascular coagulation (DIC)?
200
During a laparoscopic cholecystectomy, this artery is ligated in the hepatobiliary triangle and runs alongside the cystic duct.
🟩 What is the cystic artery?
200
A patient with chronic alcoholism presents with confusion, ataxia, and nystagmus. Giving this before thiamine can precipitate irreversible Wernicke encephalopathy.
What is IV glucose?
🔥 Thiamine is a cofactor for glucose metabolism. Giving glucose first worsens lactic acidosis and neuronal injury.
300
RBBB
LBBB:
300
This personality disorder involves social inhibition, feelings of inadequacy, and hypersensitivity to criticism, but unlike schizoid patients, these individuals desperately want social relationships.
🟩 What is avoidant personality disorder?
300
A 67-year-old man presents with fatigue and splenomegaly. CBC shows leukocytosis with a left shift and a low leukocyte alkaline phosphatase (LAP) score. Peripheral smear shows increased basophils. What is the diagnosis?
🟩 What is chronic myeloid leukemia (CML)?
🔥 NBME trap: LAP score is low in CML, high in leukemoid reaction.
300
A 30-year-old cyclist falls with his arm extended, injuring the posterior cord of the brachial plexus. He now has wrist drop. Which nerve is most likely injured?
🟩 What is the radial nerve?
300
This autoimmune condition is the only vasculitis associated with asthma, eosinophilia, and neuropathy, and can cause mononeuritis multiplex.
What is eosinophilic granulomatosis with polyangiitis (Churg-Strauss)?
🔥 Don't confuse with PAN (no asthma) or GPA (no eosinophilia).
400
In a patient with mitral stenosis, which pressure is elevated and what murmur is heard?
↑ Left atrial pressure (reflected as ↑ PCWP)
Opening snap with diastolic rumble
Elevated PCWP with normal LVEDP helps differentiate mitral stenosis from LV failure.
400
This personality disorder involves a preoccupation with orderliness, perfectionism, and control at the expense of flexibility and efficiency. Unlike its Axis I counterpart, patients do not view their behavior as distressing.
🟩 What is obsessive-compulsive personality disorder (OCPD)?
400
A patient develops fever, chills, and mild dyspnea 6 hours after receiving a packed RBC transfusion. There is no hemolysis or hypotension. Chest x-ray shows bilateral infiltrates. What is the most likely cause?
🟩 What is transfusion-related acute lung injury (TRALI)?
⚠️ Distinguish from anaphylaxis (immediate), febrile non-hemolytic reaction (fever but no pulmonary edema), and TACO (volume overload + elevated BNP).
400
A 45-year-old obese man presents with numbness and burning pain along the lateral thigh. Exam is normal except for decreased sensation to light touch in that region. This nerve, compressed under the inguinal ligament, is the most likely cause.
What is the lateral femoral cutaneous nerve?
🔥 NBME trap: No motor deficits; purely sensory.
400
A patient with suspected epiglottitis and stridor is sitting upright, drooling, and appears anxious. The next best step is:
What is prepare for endotracheal intubation in the OR with anesthesiology and ENT on standby?
🔥 Never force this patient to lie down or do a full exam first — they can crash fast.
500
How do you differentiate distributive shock from hypovolemic shock?
SVR is low in distributive shock, high in hypovolemic
500
This personality disorder is characterized by pervasive distrust and suspiciousness of others, often resulting in hostility, difficulty with authority, and refusal of medical treatment due to belief that providers have malicious intent. Unlike delusional disorder, the suspicion is global, not fixed to a single theme.
🟩 What is paranoid personality disorder?
500
A 70-year-old man with a history of weight loss and early satiety is found to have splenomegaly and anemia. Peripheral smear shows teardrop cells, and bone marrow biopsy reveals dry tap with fibrosis. JAK2 mutation is positive. What is the diagnosis?
🟩 What is primary myelofibrosis?
eardrop cells + dry tap can also occur in metastatic cancers or hairy cell leukemia.
NBME often expects recognition of myeloproliferative neoplasm patterns, especially JAK2-positive conditions:
PV: ↑ RBC mass
ET: ↑ Platelets
PMF: Bone marrow fibrosis + leukoerythroblastic smear
500
During a total abdominal hysterectomy, a surgeon accidentally ligates a structure traveling near the uterine artery. Postoperatively, the patient develops flank pain and hydronephrosis. What structure was most likely injured?
🟩 What is the ureter?
500
A patient develops sudden-onset abdominal pain and bloody diarrhea after a cardiac surgery or hypotensive event. Imaging shows segmental colonic thickening, and labs reveal elevated lactate. What's the most likely diagnosis?
What is ischemic colitis?
🔥 Tricky because it mimics IBD or infectious colitis, but this is a low-flow vascular event, often at watershed areas (splenic flexure).