NBME CBSE ACTUAL TEST-with 100% verified answers- 2022
62 year old woman - osteoporosis - a bisphosphonate is prescribed. The expected beneficial effect
... [Show More] of the drug is due to which of the following? - Decreased Osteoclast Activity
Cohot Study of elderly women - relative risk ratio for hip fractures among those who exercise regularly is 1.2 (95% confidence interval of 1.1 to 1.8). Which of the following is the conclusion about the effect of exercise on the risk of hip fracture? - Statistically Significant Overall Increase Risk
52 year old man goes to ER with chest pain radiating to his jaw while shoveling snow. Pulse is 80/min and blood pressure is 130/70. The most immediate treatment mechanism of action? - Increased nitric oxide concentration
24 year old woman - spilled hot grease on her left leg while working at a fast-food restaurant. Exam of leg shows 7cm pink, soft, granular, edematous wound. The formation of this tissue was most likely caused by increased activity of which? - a. Vascular Endothelial Growth Factor
VEGF - stimulates angiogenesiss.
TYPE III Collagen = Blood Vessels - early wound repair
27 year old man- MVC - skull x-ray shows a linear, nondepressed basal skull fracture - increased serum osm and decreased urin osm. Following desmopressin urine osm increases. Desmopressin's effect is due to the activation of which of the following? - a. Adenylyl Cyclase
Adenylate Cyclase - ATP - CAMP -- PROTEKINASE A -- Ca v2
A 10 month old boy - 4 day history of fever and cough. He attends day care center. Chest exam shows intercostal retractions along with bilateral, diffuse wheezes and expiratory rhonchi. The infectious agent most likely has which of the following properties? - Mediation of Cell Entry via a fusion protein
A 17 year old girl in ED - 15 minutes after being stung by a bee. Mild light headedness but no difficulty swallowing- Bilateral wheezing - Which is most appropriate pharmacotherapy for this patient? - B2- Agonist
14 year old boy - 2 day history of sore throat and fever that peaks in late afternoon. 1 week of fatigue. He recentaly had sex with one partner. Physical exam show cervical lymphadenopathy and pharyngeal erythema with a creamy exudate. DX? - Infectious Mononucleosis
57 year old man - radiation therapy for squamous cell carcinoma of the lung. Despite therapy, tumor increases in size and he dies 6 months later. The progressive tumor growth is due to a defect in cell cycle arrest in which of the following phases of cell cycle? - G1
28 year old - lived in sub-Saharan Africa - until he came to the US. Temp of 100.4 - imaging shows bilateral hydroureter and hydronephrosis. Biopsy shows marked fibrosis and scattered granulomas. DX? - Schistosomiasis
A couple with a family history of a-thalassemia. Woman has one gene deletion and man has two gene deletion. If the two gene is trans - what percentage of offspring will have a two gene deletion? - 50%
previously healthy 40 year brought to emergency department by her husband - 2 day history of fever, lethargy, confusion. PE shows scattered petechiae and ecchymoses over the lower extremities - 3+ polychromasia and 3+ schistocytes and Low platelets Dx? - Thrombotic Thrombocytopenia Purpura
16 year old boy - is admitted to the ER because of a knife wound to the left side of his chest. An X-ray of the chest shows an air-fluid level in the left side of the chest, partial collapse of the left lung, and the elevation of the stomach bubble. The mediastinum is midline. DX? - Hemopneumpothorax under tension
49 year old woman - coronary artery disease - BP 140/90 - High Cholesterol, High LDL (190), High triglycerides (350) - TX with atorvastatin and losartan. What are the effects on HDL and Triglycerides? - HDL increased
Triglycerides Decreased
73 yeare old - diffuse weakness and tingling of her arms and legs. Sensation and vibration and position is decreased in all extremities. What vitamin deficiency? - Vitamin B12 - (cyanocobalamin)
Tea and Toast - low B12 in diet
15 year old girl - 3 month history of acne - which is the underlying cause of the patients acne? - Stimulation of Sebaceous Glands by androgens
b. ACNE = Propionibacterium ACNE
4 year old from Brazil - PE shows single 12x10cm lesion in the right side of jaw with diffuse regular edges. Photomicrographs of an incisional biopsy (looks like Burkitts Lymphoma/ Starry night) - which of the processes most likely to occur in the region indicated by the arrow? - Apoptosis
b. Endemic Burkitt lymphoma can happen in Brazil as well as Africa (jaw lesion, puffy face).
51 year old - lump on tongue - 1 pack smoking history for 30 years. 1.5 cm mass on apex of tongue. It is most appropriate to evaluate which lymph nodes first for evidence of metastasis? - Submental
15 year old boy - ER - 2 hour history of confusion and agitation - fever, headache, stiff neck, and vomiting - since returned from summer camp - patient is hallucinating - lumbar puncture - shows cysts and trophozoites- most likely pathogen? - a. Olfactory Nerve Naegleria fowleri
17 year old - ED - 30 minutes after being found with a blank stare. Physical exam shows rigidity. During exam he becomes hostile and assaults physician - Pt ingested which drug? - PCP
Placebo controlled clinical trial - 5000 pts with essential hypertension. 2500 patients receive new drug and 2500 patients receive placebo. If alpha is set at 0.01 instead of 0.05, which of the following is most likely result? - Significant findings can be reported with greater confidence
17 year old - gymnast - comes to hospital because of lack of menstrual period for 6 months. BMI 15 Which is the cause of the amenorrhea? - Hypogonadotropic Hypogonadism
A male stillborn is delivered at 32 weeks - Oligohydramnios - absence of a urethral opening. Which is most likely finding? - Pulmonary Hypoplasia
A 6 day old - breast fed boy in ED - poor weight gain and irritability since delivery - Physical exam shows jaundice and hepatomegaly. The concentration of which of the following metabolites is most likely increased? - a. Galactose - 1 - phosphate
b. Congenital intolerance to breast milk
A 25-year-old man - comes to ED - severe muscle pain, diffuse, painful swelling of his neck, underarms, and groin after camping in New Mexico Generalized scattered black maculae. Examination of the right upper extremity shows erythematous, solid, tender mass. Mass is draining blood and necrotic material. The most effective antibiotic for patient disorder will interfere with which of the following processes? - a. Ribosomal Assembly
b. Yersenia Pestis
45 year old - progressive weakness - muscle fasciculations of the upper extremities and weakness of the lower extremity - What additional findings? - Atrophy
b. ALS = Lou Gherig
A new severe respiratory illness - Why use a killed vaccine vs a live vaccine? - Avoids Concerns of reversion to virulence
b. Killed vaccines - avoids reversion to virulence
c. live vaccines - can (but rarely do) cause the disease they're designed to prevent
A 33 year old - keratinizing squamous cell carcinoma of cervix. Which of the following describes pathogenesis of this patient's disease? - Inactivation of Cellular P53
b. p53 protein = tumor suppressor (it activates apoptosis) - most human cancer
A 54 year old - 40 year history of T1DM - receiving hemodialysis for end stage renal disease while awaiting a kidney transplant. Receives a drug that induces reticulocyte release from bone marrow and stimulates a cytokine receptor that signals Jak/Stat pathway? - Erythropoietin
Jak Stat - erythropoietin
During a clinical study examining the effects of exercise. The average pulse is 175/min. Compared with measurement before the session, which is most likely decreased? - Total Peripheral Resistance
An 8-year-old boy - 3-day history of fever, sore throat, and itchy eyes. Returned from week long summer camp that includes hiking trips and swimming - PE shows conjunctival injection and oropharyngeal edema - Outbreak among other campers. Which is most likely cause of this patient's symptoms? - Adenovirus
Fever+ Sore Throat + Itchy Eyes transmitted via swimming pools Conjunctivitis Viral = adenovirus
44-year-old woman - 10 month history of wide red streaks over her lower trunk (striae) and weight gain in face (moonface). Which additional findings? - Hypertension and muscle weakness
b. Cushing - hypertension and muscle weakness
12 year old boy - pain below left knee -unable to play soccer - An x-ray shown - Which structures attached to the abnormal anterior tibial area? - patellar ligament
b. Osgood-Schlatter
A 65-year-old health maintenance exams - He lives is a single-family home with his cat and dog. He spend much of his time in his basement woodworking shop. This patient is increased risk for lung cancer due to which of the following environmental exposures? - Radon
54- year-old man - intense overwhelming fear. Which portion of brain stimulated? -
Amygdala
b. Fear = amygdala
30 year old woman - recurrent URI - Sweat is Salty- Genetic testing for 36 most common mutations shows detectable G551D in one allele of CFTR - What is patients clinical phenotype? - The Second CFTR Gene was not detected by the testing obtained
74 year old - COPD - "I enjoy coming to see you because you remind me of my daughter. She died 35 years ago". Which is most appropriate response by physician? - You must miss your daughter very much. Tell me about her.
b. PT = Transference
9 month old boy - awakens and cries at least once nightly and settles back to sleep after drinking a bottle of formula - Explanation for patient's sleep pattern? - Normal Development
Pubertal gynecomastia in males is norma
A 32 year old - abnormal movement in hands and worse when he feels angry - Unable to fix his gaze on one point or protrude his tongue for more than 30 sec - Pt most likely has anatomic abnormalities in which of the following locations? - Basal Ganglia
A 14-year-old boy - recurrent otitis media since infancy - underwent tonsillectomy for obstructive sleep apnea - Cardiac auscultation exam listen - shows S3 - which is most likely finding? - Normal Findings
b. normal physiologic splitting
37 year old woman - right lower extremity edema - sudden SOB+, If present on physical exam which sign would be the most specific indicator or pulmonary arterial hypertension?
- P2 louder than A2
b. Pulmonary Hypertension - Split S2
43 year old - with t2DM - ER - nausea and vomiting - after drinking champagne. Treated for Trichomonas Vaginalis Infection - TX with metronidazole. What is cause of nausea and vomiting? - Accumulation of Acetaldehyde
b. Metronidazole - disulfiram reaction
45 year old man - right shoulder pain - patient unable to externally rotate the shoulder against resistance - Which of the following tendons is inflamed? - Infraspinatus
b. SITS Muscles
c. Teres Minor and Infraspinatus external rotation d. Innervated by Suprascapular Nerve
A 44 year old man - 6 week feet numbness - chemotherapy with vincristine - MOA of Vincristine? - Depolymerization of Microtubules
10 year old - 95th percent height and 25th weight - Nurse thinks she has marfans - Molecular testing for FBN1 Gene shows single nucleotide change does not change amino acid at the locus - Explain the single nucleotide change in the patient and the mother? - It is a polymorphism
26 year old woman - ED - 2 day history of runny nose - Patient has to wait 6 hours before she is seen. In addition to apologizing, which of the following is the most appropriate remark? - Thank you for waiting. How can I help you today?
A 26 year old man - ER -m 30 minutes after being shot in the leg - Pulse is 120/min, respirations are 16 /min - blood pressure is 80/60. Findings compared with healthy adult?
- Baroreceptor Firing decreased SVR increased
Pulmonary Vascular Resistance Increased Absorption Increased
e. BARORECPTOR - stretch receptors - mirror BP - decreased in hemorrhagic shock
A 36 year old man - fluid is presenting adbomen in which of the following areas as indicated by the arrow? - Omental Bursa (lesser sac)
What is the positive predictive value (refer to chart)? - .67 Probability that a patient with a positive test has a disease A/(A+B)
A 75 year old woman with T2DM and HTN - Emigrated from Argentina - Which of the following is the most appropriate person to serve as an interpreter for this patient encounter? - Telephone Interpreter
During a study of renal glomeruli - if efferent arteriole is constricted - which starling forces are likely to change in the glomeruli? - Increased Hydrostatic Pressure
2 year old with neurocognitive dysfunction - fine during birth - both parents have learning disabilities - maternal uncle with cognitive disabilities - Irritable making eye contact with flapping his hands? - Trinucleotide Repeat Expansion
b. Fragile X - intellectual disability - trinucleotide repeat in FMR1 gene
A 33 year old man - undergoes radical thyroidectomy - postop serum calcium is 7.5 and albumin concentration of 4g/dl - PTH concentration of 200 - damage to which vessel causes finding? - Branch of Thyrocervical Trunk
b. inferior thyroid arteries, which arise from the thyrocervical trunk. c. External carotid - superior thyroid
46 year old woman - 2 month history of fatigue and muscle weakness - 10 year history of hypertension - treated with thiazide diurectics - measured hypokalemia, hypotension and decreased BP- brisk reflexes. Likely cause? - Adverse Drug Effect
b. Treated with a thiazide diuretic for HTN with measured hypokalemia, hypotension and decreased Hg
55- year old man - nice to nurses - mean to youngest child- Which is the most likely explanation of patient's behavior? - Splitting
b. Cluster B - borderline personality (BANH)
A Study designed to evaluate the feasibility of acupuncture in children with chronic headache - 60 children recruited - In addition to their usual therapy - all children are treated with acupuncture three times per week for 2 months - Describe findings? - Case- Series
6 year old girl - 1 week history - lots of infections -raised neutrophil count- but cells show a delay in bactericidal activity against Staph Aureus- Most likely cause? - Myeloperoxidase
2 year old boy - severe pain, swelling, and redness of his left thumb (image). PE shows oral vesicle, cervical lymphadenopathy - infectious agent causing findings in thumb? - DNA Virus
Herpetic Whitlow
Herpetic Whitlow - vesicles on fingers
7 year old - lives in Kentucky - 2 week history of cramping abdominal pain and diarrhea - mother looked in underpants and saw earthworm - no travel history- Transmission via? -
Ingestion of Soil
b. Ascaris - fecal oral transmission
23 year old man with multiple sex partners - dysuria and yellow urethral exudate - Gram Stain - numerous neutrophils - many contain gram negative diplococci. He had 3 episodes over the past 2 years. Which property of the organism - explains reinfection? - Antigenic Variation
b. Gram negative Diplococci
c. N. gonorrhea can change its pilus,
23 year old woman - genetic counseling - brother and maternal uncle had Duchene Muscular Dystrophy - Serum CK of 120 - and mother serum CK 300- What is assessment of carrier status? - The patients DMD carrier status is uncertain because of random X Inactivation
b. Barr Body
c. DMD is X-linked.
20 year old woman - heavy bleeding - Platelet Aggregation is normal - PTT elevated - no easy bruising - Which hemorrhagic disorder cause of patients menorrhagia? - Von Willebrand Disease
B. Platelet aggregation time being normal, ok fine I can see that.
32 year old man - ER - for MVC - urethral injury - blood noted at the uretheral meatus.
Which portion of the urethra would be at greatest risk of injury? - Membranous a. Pelvic fracture - MVC
b. Pelvic Straddle injury = Bulbar (spongy) urethera
A 63 year old - ED - unresponsive - Crackles heard over left upper and entire right lung. Pt dies. Photograph of section of right lung obtain - Which is likely cause of the position indicated by the arrow? - C5a
Complement system calls in neutrophils C5a = neutrophil chemotaxis
A 22 year old woman - 6 months sever lower backpain - endometrial biopsy shows abundant mitotic figures in the endometrial glands and stroma. Which protein or enzymes regulate the progression of this phase of the menstrual cycle? - Cyclin Dependent Kinase.
29 year old woman - prescribed carbamazepine for trigeminal neuralgia- family history of osteoarthritis - the most likely reason for this recommendation is that carbamazepine may affect which of the following processes? - Metabolism
An 18 year old woman - fever, dizziness, weakness, and vomiting (toxic shock) - using synthethic pads and tampons - Physical exam shows injected conjunctiva and rash- Pts use of which increased risk? - Tampons
A 53 year old man - - 6 month history of blood in stool - 1 cm anal mass - If mass is malignant, evaluate which lymph nodes? - Superficial Inguinal
1 cm mass below dentate line
24 year old - brought to ED - MVC - face struck steering wheel - facial pain and double vision - Exam of left eye shows infraorbital edema - ocular movement restricted vertically - CT scan shown. Which of the following impaired on left side? - Sensation over the upper lip
V2 = maxillary nerve
23 year old - collapsed at finish line - no loss of consciousness Associated with prolonged use of vaginal tampons or nasal packing She is placed on a cot - feet elevated - 30 minutes later her blood pressure is 110/70 mm Hg. Which described patients condition? - Orthostatic Hypotension
.decrease in systolic blood pressure of 20 mm Hg (110-85) e. decrease in diastolic blood pressure of 10 mm Hg. (70-50)
27 year old - ER - pain in navel - nausea and one episode of vomiting 1 hour ago - underwent appendectomy 2 years ago- CT scan of abdomen shows fat stranding in small bowel with areas of inflammation in terminal illeum - 2 cm bulge on antimesenteric border of the inflamed segment. Histological specimen - most likely to show which of the following? - Gastric Mucosa
b. Crohns with the multiple episodes over the last year, fat stranding, terminal ileum involvement
14 year old girl -parents divorced - starts acting sullen, defiant, and truant at school, sexual intercourse with new partners and no condoms, previously honor studenty- which defense mechanisms? - Acting Out
38 year old - pregnant woman - ultrasound shows oligohydramnios and a full term fetus with a large kidney and empty right renal fossa. Need history on maternal use of which during pregnancy? - ACE Inhibitors
A 65 year old - bilateral wheezing - accumulation of which of the following? - Leukotrienes
19 year old - with asthma - comes to ER multiple times for acute asthma exacerbations - "All doctors don'g understand me" - they keep prescribing steroid inhalers. What is the
most appropriate statement by the physician? - Tell me more about what you know about steroid inhalers and how are they supposed to work?
A healthy 22 year old man - in study for glucose metabolism - He consumes an 800 calories meal consisting - 12 hours later serum glucose is within reference range - Which is involved in maintaining serum glucose? - Glycogenolysis of Liver
30 year old man - 6 week history of colicky abdominal pain and diarrhea with occasional blood - on autopsy - small bowel is seen in the wall of a thickend loop of small intestine - Photomicrographs (granulomas)- DX? - Crohns Disease
A 3 month old boy - 2 hour respiratory distress - Physical exam shows cyanosis - blood sample appears brown - most likely cause of patients condition" - Decreased activity in the enzyme that reduced Fe3+ to Fe 2
a. the hypoxia and the "blood sample appears brown" should point you towards methemoglobinemia.
b. if you want a fun video from "9-1-1" that actually explains a lot of it: c. methemoglobinemia = cyanosis and chocolate colored blood.
68 year old - 1 day history of fever and swelling in left leg - cellulitis - gram stain - gram positive, catalase negative cocci - clear zones of blood agar - Which species of Streptococcus? - Strep Pyogenes
67 year old woman - bicuspid aortic valve - admitted to the hospital - 2 day history of fever and chills. Blood culture grows viridans streptococci - In addition to penicillin, which other drug is administered to shorten the duration of treatment? - Binding to 30S protein
12-year-old girl - 2 month history of intermittent yellowing of the eyes and skin - PE - no abnormalities except jaundice. Total bilirubin 3mg/dl unconjugated bilirubin > Direct - Findings in patient? - Decreased activity of UDP glucoronylytransferase
During an experiment, drug X is added to a muscle bath containing a strip of guinea pig intestinal smooth muscle. Agonists are added to the bath, and the resultant effects on muscle tension are shown in table. Acetylcholine increased. Which of the following drugs most likely to produce effects most similar to those of drug X? - Cholinesterase Inhibitor
30 year old women - 28 week gestation - Fetal ultrasound normal - Father's blood group in B, Rh Positive - Physician recommends administration of Rh0D immune globulin - This treatment is most likely to prevent? - Formation of antibodies to RhD
55- year -old -man - hypertension and chronic kidney disease - ECG shows low voltage with electrical alternans. Physical exam is most likely to show which of the following? - BP 85/60
Pulse 120
JVP Increased
Pulse Paradoxus Increased
a. Electrical Alternans = Cardiac Tamponade = pleural effusion b. Beck Triad - Hypotension, JVP, muffled heart sounds
52-year-old - newly diagnosed with Type 2 diabetes mellitus. Four weeks later, her hepatic glucose out is decreased and target tissue glucose uptake are increased. Which agent? - Metformin
An asymptomatic 44-year-old man - with HIV infection during routine screening to donating blood. A complete blood count- platelets are low - which of the following finds are most likely? - Petechiae
Platelet problem - epistaxis, ecchymoses, petechia, bleeding from superficial scratches
Coagulation problem - late re-bleed, Menorrhagia, GI bleeds, hemarthroses
23 year old - bone marrow failure - given a large dose of rabbit antimyocyte globulin - 10 days later - develops fever, lymphadenopathy, arthralgias, and erythema on her hands and feet. Which is the most likely cause of these symptoms? - Immune complex deposition in tissues
b. Serum sickness - TYPE 3 hypersensitivity
42 year old - gunshot wound - 36 hours post-operatively she is receiving morphine. she needs morphine - she has expressed concern she is becoming addicted. Which of the following initial actions by the physician is most appropriate? - Reassure the patient has a miniscule chance of becoming addicted to narcotics
A 22 y/o woman -- itchy, red rash on her arm - new hair dye - picture (contact dermatitis) - Which ligand pairs play a role in the proliferation of the T Lymphocytes - CD28 on T Lymphocytes and CD80 on epidermal Langerhans cells
6 healthy subjects in a study of muscle metabolism - Increased malonyl-CoA directly inhibits which of the following processes in these subjects - Fatty Acid Oxidation
b. Malonyl-CoA inhibits the rate limiting step in beta-oxidation of fatty acid.
Over 1 year - study is conducted to assess the antileukemic activity of a new tyrosine kinase inhibitorwith CML in blast crisis - All patients in the study had SML and are informed that they would be treated with tyrosinase inhibitor. What type of study design? - Open Label Clinical Trial [Show Less]