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PATHOLOGY NBME EXAM | ALL
QUESTIONS AND CORRECT ANSWERS
(ALREADY GRADED A+) | LATEST VERSION
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54yo F 1 week after sudden loss of vision in left eye, returned within 1 day. 3 - month hx of progressive SOB with exertion. Echocardiography shows mass in the left atrium of the heart. Lesion is resected, photomicrograph of it is shown. Which describes the lesion? ---------CORRECT ANSWER-------- ---------myxoma 27yo primigravid woman at 34 weeks' with nausea and vomiting, and abdominal pain for 12 hours. Everything's been normal. BP is now 164/102, and right upper quadrant tenderness. Labs show Hb 7.4, HCT 24%, Platelets 72k, Cr 1.2, total bili 2.3, AST 112, ALT 126. Peripheral blood smear will show? ---------CORRECT ANSWER-----------------Schistocytes 60yo F 3 hours after sudden onset ankle pain. 4-year Hx of increasing serum creatinine concentrations. Began furosemide 1 month ago, also takes glipizide. P 120/min, resp 25/min, BP 150/100. Joint fluid shows negatively birefringent crystals. Increased risk of which complications of underlying process causing joint findings? ---------CORRECT ANSWER------ -----------Nephrolithiasis 56yo F follow-up 8 weeks after recovering from pneumococcal pneumonia. Chest X-rays normal. Which allowed this resolution to occur? --------- CORRECT ANSWER-----------------Maintenance of basement membrane integrity
29yo F with 5-week hx of fatigue and 4-day hx of heart palpitations and anxiety. Has primary hypothyroidism Rx with triiodothyronine, but she has doubled the dose because of fatigue. TFT will show which? --------- CORRECT ANSWER-----------------TSH DECREASED, Free thyroxine DECREASED, Free triiodothyronine INCREASED 20yo F has multiple neurofibromas. Mom, uncle, and brothers with similar lesions. Mode of inheritance? ---------CORRECT ANSWER----------------- Autosomal dominant 45yo M with yellow skin. Drinks eight to ten 12-ounce cans of beers daily for 10 days. Liver is tender. Serum: total bili 5.9, Alk Phos 210, AST 110, ALT 69, gamma-glutamyltransferase 25 (n = 0-30). Liver biopsy will show? ---------CORRECT ANSWER-----------------Mallory hyaline 50yo M smoked 2 packs per day for 34 years, with SOB on exertion, chronic cough, and wheezing. Increased AP diameter, diminished breath sounds, scattered rhonchi. Which Lab abnormalities is expected? --------- CORRECT ANSWER-----------------Increased blood HCO 35yo M uses crack cocaine daily, with 2-hour Hx of substernal chest pain. T 37C, P 110/min, BP 160/100. Most appropriate next step? --------- CORRECT ANSWER-----------------Admit the patient to the hospital for possible myocardial ischemia 54yo F with hypertension and bilateral renal artery stenosis starts taking NSAIDS for back pain. Her Cr concentration increases from 1.0 to 5.0. Cause is due to inhibiting which? ---------CORRECT ANSWER----------------- Vasodilating prostaglandins at the afferent arteriole
72yo M with weakness and fatigue. Hemoglobin concentration is 9.2, WBC 5400, platelets 350k. Peripheral blood smear is shown. Cause? --------- CORRECT ANSWER-----------------Gastrointestinal blood loss 65yo F with widely metastatic breast cancer unresponsive to chemo. No family. "close friend," at all her visits and now she is moved to inpatient hospice after she decides she wants no further curative therapy. Says, "We can't bear to be apart. It would be cruel to separate us now.". Which response is appropriate? ---------CORRECT ANSWER-----------------"The two of you seem to have a very important relationship. Of course you may stay together." 46yo M treated with oral cyclosporine after cardiac transplant. Cyclosporine decreases likelihood of rejected by which actions? ---------CORRECT ANSWER-----------------Suppressing the early response of T lymphocytes to activation 30yo M in ED 15 minutes after found unconscious. Comatose, pupils 4 mm in diameter, not reactive to light. CT head shown. Cause of coma is bleeding from which structures? ---------CORRECT ANSWER----------------- Middle meningeal artery 68yo M with 6-month hx of erectile dysfunction. PE and labs normal. If pharmacotherapy is indicated, drug with which MOA? ---------CORRECT ANSWER-----------------Inhibition of phosphodiesterase 35yo M with recurrent sinusitis and bronchitis. Cardiac examination shows PMI at fourth intercostal space within the midclavicular line on the right. Hepatic margin is palpable on the left. Endoscopy shows nasal polyps. Biopsy shows thickened, ciliated, pseudostratified epithelium with small
patches of squamous metaplasia and mild lymphoid infiltration. Which structure most likely to be absent on electron microscopic exam of epithelium? ---------CORRECT ANSWER-----------------Dynein arms 30yo primi at 22 weeks' gestation with 1-day hx of fever, chills, and muscle aches. T 39.4, P 114/min, resp 15/min, BP 104/72. PE shows uterus consistent with 22-week gestation. Fetal heart sounds are heard. WBC 12K, Blood cultures grow gram-positive rods. Causal organism? --------- CORRECT ANSWER-----------------Listeria monocytogenes 42yo M with multiple lesions over his body. PE shows flaccid bullous erosions involving upper and lower extremities and torso. Biopsy shows extensive epidermal acantholysis resulting in the formation of intraepidermal blister. Intact basal layer of keratinocytes adherent to basement membrane is identified. Which is related to pathogenesis? --------
- CORRECT ANSWER-----------------Development of autoantibodies against desmosomal proteins 50yo M 3 days after his first generalized tonic-clonic seizure. 1-month hx of frequent episodes of pins-and-needles sensation around the mouth, hands, and feet, involuntary contraction of muscles. Neuro exam shows mild, diffuse hyperreflexia. Which serum electrolyte is abnormal? --------- CORRECT ANSWER-----------------Calcium 52yo F with hot flashes. Menses have been irregular for the past 6 months. Physiologic cause? ---------CORRECT ANSWER-----------------Failure of the ovaries to secrete 17 beta-estradiol 32yo F G2P1 at 7 weeks' gestation with vaginal bleeding for 3 days and increasingly severe left abdominal pain for 18 hours. Direct and rebound
DECREASED, FSH DECREASED. Explanation? ---------CORRECT ANSWER-----------------Increased intestinal iron absorption 45yo M with intermittent bloody diarrhea and abdominal pain. Sigmoidoscopy and rectal biopsy show IBD. Monoclonal antibody is begun, which is directed against what components? ---------CORRECT ANSWER-- ---------------Tumor necrosis factor (anti-TNF alpha like infliximab) 41yo F with increasingly severe headaches for 6 weeks. BP 160/100. bruit over left costovertebral angle. U/A normal. Angiogram of left renal artery shows alternating areas of stenosis and aneurysmal dilatation ("string of beads" sign). Dx? ---------CORRECT ANSWER-----------------Fibromuscular dysplasia 55yo M with sepsis. Appears anxious and confused. Rx with vancomycin and ceftriaxone initiated in ED. T 39.8, P 132/min, BP 85/48. PE shows warm, flushed skin. No edema. Administer which solutions? --------- CORRECT ANSWER-----------------0.9% Saline 36yo M undergoes elective liposuction under general anesthesia. Operation is terminated when patient develops hyperthermia, tachycardia, and marked muscle rigidity. MOA of drug that should be administered? ----- ----CORRECT ANSWER-----------------Decreases release of Ca from the sarcoplasmic reticulum (dantrolene) In a survey of 100 households (average three residents per household), 45 with asthma are detected. Prevalence? ---------CORRECT ANSWER--------- --------15%
While lifting weights, 24yo M swelling in right inguinal region. Photograph shown of small intestine resected. Dx? ---------CORRECT ANSWER---------- -------Strangulation 24yo with second-degre burn. Two weeks after, tissue shows increased fibroblast migration and proliferation, increased collagen and fibronectin, and decreased metalloproteinases. Caused by production of which? --------- CORRECT ANSWER-----------------Transforming growth factor-beta (TGF) Protein found in brown adipose tissue of mice causes leak of H ions inward across inner mitochondrial membrane. Effect of this protein on oxidative phosphorylation and energy metabolism? ---------CORRECT ANSWER------ -----------Increased ratio of oxygen consumption to ATP generation 57yo M with alcoholism has distended abdomen with shifting dullness, fluid wave, caput medusae, palmar erythema, spider angioma. Additional finding? ---------CORRECT ANSWER-----------------Gynecomastia 16yo girl with 2-year hx of fainting; increased in frequency during past 6 months. BP 110/80 supine and 60/40 standing. Neuro exam normal. Plasma shows undetectable norepinephrine and marked increase in dopamine concentration when standing. Deficiency of which? --------- CORRECT ANSWER-----------------Dopamine beta-hydroxylase 20yo M with suspected appendicitis has periumbilical burning and discomfort, localizes to RLQ 5 cm superomedial to anterosuperior ilica spine. This is because periumbilical region and appendix are both supplied by afferent fibers in dorsal root ganglia of which levels? ---------CORRECT ANSWER-----------------T
wright-stained peripheral smear shown. Dx? ---------CORRECT ANSWER--- --------------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 ANSWER- ----------------Lisinopril 66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving chemotherapy with fluorouracil, leucovorin, and Irinotecan. prescribed opioid antidiarrheal agent with no CNS effects. Which med? ----- ----CORRECT ANSWER-----------------Loperamide 35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse, watery diarrhea 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 ANSWER-----------------Activation of 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 tumor in which location? --------- CORRECT ANSWER-----------------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 newborn. Explanation? ---------CORRECT ANSWER-----------------Congenital cytomegalovirus infection Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/ 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 postconception (in days)? -- -------CORRECT ANSWER-----------------15 to 40 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 ANSWER-----------------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 ANSWER--- --------------L3 to L 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 ANSWER----------------- contemplation
Newborn has male genital ducts but female external genitalia. Cytogenetic analysis shows a 46,XY karyotype, and genetic testing shows a mutation of the gene encoding 5alpha-reductase. In absence of this mutation, labia majora would have been? ---------CORRECT ANSWER----------------- scrotum Study designed to evaluate the efficacy of coenzyme Q10 in improving cardiac output in patients with CHF. Sixty patients with CHF are recruited. Each assigned by coin toss to one of two groups. Design? --------- CORRECT ANSWER-----------------randomized clinical trial 12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological changes? ---------CORRECT ANSWER-----------------Central blood volume INCREASED, ADH (vasopressin) DECREASED, Atrial Natriuretic Peptide INCREASED? C (block3, q23) Randomized controlled study of 2000 patients with insomnia is conducted to evaluate the efficacy of a new medication to treat this condition. Ten subjects from both the control and treatment groups do not complete the study are not included in the analysis. Treatment group able to fall asleep 5 minutes faster than control (p=0.001). Neither group report an improvement in quality of life. Conclude that new med is efficacious in treating insomnia. Type of error? ---------CORRECT ANSWER-----------------Failure to distinguish between statistical significance and clinical significance 18mo girl. Separation of the umbilical cord was delayed after birth. Has had four severe skin infections Staphylococcus aureus; No pus formation at infection sites. Persistent leukocytosis in absence of infection. Mechanisms impaired? ---------CORRECT ANSWER-----------------leukocyte adhesion and transmigration
50yo M with increasing cough for 6 month and hemoptysis for 1 week. Smoked 1 pack per day for 32 years. Plays squash, swims. CXR shows a 3 x 4-cm hilar mass. Cytologic examination of sputum shows a non-small cell carcinoma. Tells patient he has lung cancer. The patient responds, "How can this be happening to m? I eat right and exercise." Appropriate response? ---------CORRECT ANSWER-----------------"It must be difficult for you to accept this diagnosis when you feel healthy." 32yo M with 6-month hx of low back pain and stiffness, worse in morning and improve during the day; the pain radiates to his buttocks but not down his legs. Back stiffness if he sits for prolonged periods. Which to confirm diagnosis? ---------CORRECT ANSWER-----------------X-rays of the sacroiliac joints 17yo boy with 8-kg weight gain during the past year. No medical illness. BMI is 32. He asks, "Do you think that my weight gain is inherited from my father?" Appropriate response? ---------CORRECT ANSWER----------------- "Yes, your weight gain can be caused by genes and environment combined." 52yo M neighbors have reported that he has been confused and not taking care of himself. 4-mo Hx of diarrhea. PE shows extreme muscle wasting, stomatitis, and a diffuse rash that is worse in sun-exposed areas. Diagnosis? ---------CORRECT ANSWER-----------------pellagra 80yo F with suspected temporal arteritis (TA). ESR is 100, Pretest probability for TA is 50% in this patient. In the evaluation of TA, ESR has a sensitivity of 99% and specificity of 60%. Based on the results of the ESR testing, most appropriate next step? ---------CORRECT ANSWER------------- ----Additional testing to confirm the diagnosis of TA
40yo F with mole on her back that has increased in size during past 4 months. PE shows raised irregular lesion with variegated black-tan pigmentation and ill-defined margins. Pleomorphic, hyperchromatic cells within clear islands that tend to collapse. Extends from epidermis into papillary dermis. Dx? ---------CORRECT ANSWER-----------------melanoma 42yo farmer has a 7-mm red scaly plaque on helical rim of left ear. Photomicrograph shown. Dx? ---------CORRECT ANSWER----------------- actinic keratosis 30yo F training for a marathon, running 20 miles/day. Fasting glucose is 60. After her glucose stores have been depleted, which organ, in addition to liver, releases glucose? ---------CORRECT ANSWER-----------------kidney Male newborn at 28 weeks'. Given ventilatory support with up to 80% oxygen for the next 72 hours, but dies of resp. failure. Cause is inadequate secretion from which labeled cell types? ---------CORRECT ANSWER-------- ---------D. type II pneumocyte (produces surfactant) 9yo girl with poor growth during the past year. < 3rd %ile for height and at 10th percentile for weight. PE normal. Visual field testing shows bitemporal hemianopia. Labs show GH deficiency. MRI shows calcified cystic mass in suprasellar region. Tumor derived from? ---------CORRECT ANSWER-------- ---------Diverticulum of the roof of the embryonic oral cavity 28yo F G1P1 with 2-day history of a painful mass in her right breast. Delivered healthy female newborn 3 weeks ago, and been breast-feeding since. T 37C, PE shows 3-cm tender mass surrounded by an area of erythema beneath the right areola. Causal org? ---------CORRECT ANSWER-----------------staph aureus
3yo boy with bacterial colitis caused by Salmonella enterica serovar arizonae. Which factor accounts for recruitment of PMNS to inflammatory site by intestinal epithelial cells? ---------CORRECT ANSWER----------------- IL- 8 27yo F with fever, malaise, abdominal pain, and vaginal d/c for 4 days. LMP 5 days ago. Had ectopic 1 year ago. T 38.3 C, bilateral lower quadrant tenderness with rebound and guarding. Pelvic exam with cervical motion tenderness and bilateral adnexal tenderness WBC 18k. Pregnancy test neg. Dx? ---------CORRECT ANSWER-----------------Gonorrhea (PID) 20M with 3-month hx of progressive thirst (drinking a lot of fluids) and urinary frequency during past 3 days. U/A shows specific gravity less than 1.006. Most likely has dysfunction of which endocrine structure? --------- CORRECT ANSWER-----------------posterior pituitary gland (ADH) 21yo M in ED with excruciating anal pain for 4 hours. Exam shows 15-mm, blue tinged rounded mass at anal margin. Represents thrombus in a tributary of which blood vessel? ---------CORRECT ANSWER----------------- inferior rectal vein 6 - week-old girl with 6-day hx of vomiting small amount of milk 2 to 3 times daily. 50%ile for length and weight. Cause? ---------CORRECT ANSWER---- -------------Immature lower esophageal sphincter 37yo M with 4-day hx of diarrhea and abdominal pain, worse in past 24h, with watery-brown stools. Completed a 10-day course of amoxicillin for a
reflux. Thin. Physical exam otherwise normal. Itraconazole interacts with which drug and account for lack of effect of itraconazole? --------- CORRECT ANSWER-----------------omeprazole 20yo man with 6-hour difficulty breathing and vomiting. 10-year history of type 1 diabetes on insulin. Pulse 90, respirations 30 and deep, bp 90/60. Physical shows dehydration. Labs: Na+ 130, K+ 6.5, HCO3 5, glucose 500, pH 7.2, pCO2 25 mm Hg. Which compound stimulated hormone-sensitive lipase in adipocytes causing accumulation of metabolites causing acidosis? ---------CORRECT ANSWER-----------------epinephrine Physician sad to inform patient of progression of carcinoma to the terminal phase. Physician's face makes patient cry and ask, "It's bad news, isn't it?" Which is best response? ---------CORRECT ANSWER-----------------"Yes, it is." 75yo man 2-year history of decreased force of urinary stream, urinate several times throughout night. BUN 55, Cr 5.0. Ultrasound shows bilateral hydronephrosis and dilated ureter. Mechanism of renal failure? --------- CORRECT ANSWER-----------------Increased hydrostatic pressure in Bowman space 4yo boy two bacterial urinary tract infections past year. Physical exam normal. Radiologic studies show dilation of left ureter and renal pelvis, minimal left-sided renal function. Left nephrectomy done. Photo: dilated renal pelvis and ureter. Which is cause of renal disease? ---------CORRECT ANSWER-----------------congenital urethral obstruction 45yo man poorly controlled type 2 diabetes 1-month low-grade fever. Getting hemodialysis for end-stage renal disease. T 37 C (98.6 F), pulse
72, bp 144/92. Physical subclavian catheter below right clavicle. Lungs clear. Cardiac exam no murmurs. Blood cultures grow nonhemolytic, catalase-negative, gram-positive cocci in pairs and chains. Which organism? ---------CORRECT ANSWER-----------------Enterococcus faecalis 3yo boy sickle cell disease with fever and pain over left foot 3 weeks. Hematocrit stable. Leukocyte count 15,000 predominance of neutrophils. Which is most likely explanation for findings? ---------CORRECT ANSWER-- ---------------osteomyelitis 10yo girl well-child examination. No menstrual period. 50th percentile height and weight. Physical exam absence of breast bud development and no pubic or axillary hair. It is most appropriate to tell mother that first objective sign of puberty will be which? ---------CORRECT ANSWER--------- --------Breast bud development 45yo woman follow-up exam after 8 weeks tamoxifen therapy for estrogen and progesterone positive invasive ductal carcinoma of breast. 50yo sister also hormone-sensitive breast cancer. Physical exam normal. Serum decreased concentrations of endoxifen, active metabolite of prodrug tamoxifen. Genetic analysis shows homozygous cytochrome P450 2D6* alleles. Likelihood patient's sisters has same alleles? ---------CORRECT ANSWER-----------------25% 60yo man progressive shortness of breath past 3 months. Worked in shipyard. Respirations 25. Bilateral basilar crepitant crackles. Xray chest reticulonodular pulmonary infiltrates consistent with interstitial fibrosis. Picture: sputum sample of elongate structures (ferruginous body). Fibrosis initiated by interaction of structures with which cell? ---------CORRECT ANSWER-----------------Alveolar macrophages
