NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS LATEST 2023-2024 (Usmle step 1) MEDICAL EXAMINATION
70yo M dies in a motor vehicle collision. Was
... [Show More] undergoing evaluation for occult blood in the stool. Photo of transverse colon shown. Dx?
Correct Ans: - Tubular adenoma or villous polyp. GI blood loss suggests a risk for malignancy
38yo M truck driver with 1-week hx of watery, itchy eyes and a runny nose. Physical shows inflamed nasal mucosa. No congestion in lower lung. Pharmacotherapy?
Correct Ans: - Loratadine--> less sedating antihistamine
16yo girl with 3-day hx of fever, non-productive cough, and fatigue. T 38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR shows bilateral interstitial infiltrates. Blood spontaneously agglutinates while awaiting transport to the laboratory. Antibody isotypes causing agglutination?
Correct Ans: - IgM (mono and mycoplasma)
24yo M with small tender blisters on his penis 3 days after unprotected sex. Photograph shown. Causal agent?
Correct Ans: - HSV-2
42yo F with 3-year hx of an intermittent facial rash, including the forehead, eyelids, nose, and cheeks. Rash seems to be getting worse since she moved from New York to Florida last year. Spicy foods precipitate a flushing reaction that seems to exacerbate the rash. PE shows erythema over the nose and cheeks, with scattered telangiectasias and a few papules. Dx?
Correct Ans: - Rosacea
53yo M returned from Africa, has fever, headache, and abdominal discomfort. Received appropriate vaccinations prior to the trip. T 39.4C. A wright-stained peripheral smear shown (ring forms in RBCs). Dx?
Correct Ans: - Malaria
68yo F with T2DM and hypertension that has been poorly controlled despite hydrochlorothiazide treatment. BP 150/96, Labs show serum glucose concentration of 130 and proteinuria. In addition to current Rx, which is most appropriate pharmacotherapy?
Correct Ans: - ACE I (Lisinopril)
66yo M with stage IV colon cancer with 3-day hx of severe diarrhoea after receiving chemotherapy with fluorouracil, leucovorin, and irinotecan. Prescribed opioid antidiarrheal agent with no CNS effects. Which med?
Correct Ans: - Loperamide
35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse, watery diarrhoea for 8 hours despite a lack of oral intake. Recently returned from a medical relief trip to a remove village in Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin and decreased capillary refill. Stool for occult blood is negative; stool is gray and turbid. Gram stain shows gram-negative, comma-shaped bacteria; no erythrocytes of leukocytes. MOA of toxin?
Correct Ans: - V. Cholerae--> activates AC (adenylyl cyclase)
59yo F with gradual onset of lack of muscle control in her left arm and leg. Sx 1 mo ago after dx with metastatic breast cancer. PE shows ataxia of left upper and lower extremities. Muscle strength, DTR, sensation, proprioception normal. Metastatic tumour in which location?
Correct Ans: - Cerebellum
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial rash, microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in mother, + in newborn; IGM - in mother, + in new-born. Explanation?
Correct Ans: - Congenital CMV infection
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5 min. PE shows a bulging, fluod0filled mass approximately 5 cm in diameter in the midline over the lumbosacral region. No spontaneous movements of the lower extremities. Abnormality most likely occurred because of abnormal development during which periods of post conception (in days)?
Correct Ans: - 15-40; neutral tube closes at about 4 weeks
64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial fibrillation. Intravenous ibutilide is administered. Ten minutes later, ECG shows normal sinus rhythm. Risk for which drug effect in the next 6 hours?
Correct Ans: - Torsades de pointes
65yo F with 20-year hx of osteoarthritis of the hands now has pain radiating down the distal anterior thigh, knee, medial leg, and food. Bony outgrowth of vertebrae compressing one of the spinal nerves is suspected. Nerve root in which intervertebral foramina is effected?
Correct Ans: - L3 to L4
38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic agent, he has tried diet and exercise. BMI 32. PE normal. Hb A1c is 10%. Physician recommends initiation of insulin injections. Responds, "I know that insulin would help control my blood sugar. But a lot of people in my family have diabetes, and insulin made them really sick at times. Patient is at which stage of change?
Correct Ans: - Contemplation
24yo M with 2-day history of an itchy rash on his arms and legs. Returned from a camping trip in the woods 5 days ago. PE shows edematous, erythematous rash with linear vesicles. Cause is activation of which cell types?
Correct Ans: - T-lymphocytes (type IV HS)
70yo M from china with poorly differentiated monoclonal carcinoma of the nasopharynx. DNA probes of neoplastic cells are most likely to detect genome of which virus?
Correct Ans: - EBV
24yo M with hx of IVDA could not be aroused. Friend reports that the patient injected himself with a drug 6 hours ago. Labs show drug concentration of 0.3. Assuming first-order one-compartment kinetics, has a half-life of 2 hours, and a volume of distribution of 200 L in this patient. What is quantity of drug (in mg) injected?
Correct Ans: - = 200 (0.3) =60
3 half-lives = 120, 240, 480 [Show Less]