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NBME CBSE EXAM QUESTION BANK ALL WITH
600 QUESTIONS AND CORRECT DETAILED
SOLUTIONS JUST RELEASED THIS YEAR
QUESTION: 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 postconception (in days)? - ANSWER✔✔15 to 40 QUESTION: 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? - ANSWER✔✔torsades de pointes QUESTION: 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? - ANSWER✔✔L3 to L QUESTION: 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? - ANSWER✔✔contemplation QUESTION: 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? - ANSWER✔✔T lymphocytes QUESTION: 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? - ANSWER✔✔EBV QUESTION: Epidemiologic study of aniline dye, 500 workers with bladder cancer and 200 workers without. Exposed to aniline dyes/Have Bladder cancer: Yes/Yes (250), Yes/No (50), No/Yes (250), No/No (150). Odds ratio? - ANSWER✔✔ 3 QUESTION: 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? - ANSWER✔✔ 480 QUESTION: Compound is taken up by bacterial cells. No energy is necessary for uptake, and the compound is not concentrated in the cell. Which describes this mechanism of transport? - ANSWER✔✔carrier-mediated diffusion
leukocytosis in absence of infection. Mechanisms impaired? - ANSWER✔✔leukocyte adhesion and transmigration QUESTION: 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? - ANSWER✔✔"It must be difficult for you to accept this diagnosis when you feel healthy." QUESTION: 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? - ANSWER✔✔X-rays of the sacroiliac joints QUESTION: 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?
- ANSWER✔✔"Yes, your weight gain can be caused by genes and environment combined." QUESTION: 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? - ANSWER✔✔pellagra
QUESTION: 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? - ANSWER✔✔Additional testing to confirm the diagnosis of TA QUESTION: Sequence surrounding the first two exons of the human beta-globin gene shown, with exons in bold. Translation start codon is underlined. A mutation from G-->A at position 355 is most likely to lead to beta-thalassemia by which mechanism? - ANSWER✔✔Disruption of normal splicing by creation of a new 3' splice site? QUESTION: 42yo M in ED because of a 10-day history of progressive fever, SOB, and nonproductive cough. 20-kg weight loss. Immigrated to USA from the Ivory Coast 4 years ago. Temp 38C. Lungs clear, CXr shows diffuse interstitial infiltrate. Silver stain obtained via bronchoscopy shows Pneumocystis jiroveci (formerly P. carinii). High dose prednisone and trimethoprim-sulfamethoxazole is initiated, and workup for HIV infection is done. HIV ELISA positive, HIV western blot positive, CD4 22; HIV viral load <50. Explanation? - ANSWER✔✔Infection with HIV- 2 QUESTION: 27yo F with vaginal bleeding for 3 weeks. First pregnancy ended with a spontaneous abortion 8 months ago. No Rx since dilatation and curettage at that time. PE shows enlarged uterus, beta-hCG markedly increased. Ultrasonagraphy of pelvis shows material within the endometrial cavity and no intrauterine pregnancy. CT scan shows a necrotic intrauterine mass and metastatic nodules in the lungs. Site of Origin? - ANSWER✔✔trophoblastic tissue
erythema over the nose and cheeks, with scattered telangiectasias and a few papules. Dx? - ANSWER✔✔Rosacea QUESTION: 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. Dx? - ANSWER✔✔Malaria QUESTION: 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? - ANSWER✔✔Lisinopril QUESTION: 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? - ANSWER✔✔Loperamide QUESTION: 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? - ANSWER✔✔Activation of adenylyl cyclase
QUESTION: 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? - ANSWER✔✔cerebellum QUESTION: 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? - ANSWER✔✔Congenital cytomegalovirus infection QUESTION: 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? - ANSWER✔✔melanoma QUESTION: 42yo farmer has a 7-mm red scaly plaque on helical rim of left ear. Photomicrograph shown. Dx? - ANSWER✔✔actinic keratosis QUESTION: 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? - ANSWER✔✔kidney
QUESTION: 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? - ANSWER✔✔posterior pituitary gland (ADH) QUESTION: 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?
- ANSWER✔✔inferior rectal vein QUESTION: 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? - ANSWER✔✔Immature lower esophageal sphincter QUESTION: 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 sinus infection 5 days ago. Stool shows: Fecal fat negative; ova and parasites negative; Cx for infx negative; C. Diff toxin positive. Which pathologic findings present in intestinal tract? - ANSWER✔✔Pseudomemnbranes of fibrin and inflammatory debris QUESTION: 28yo M in ED 30 minutes after SOB. 3-year hx of cocaine abuse. T 38.1, P 100/min, BP 150/45. PE: diminished pulses in left upper extremity. Crackles heard over all lung fields. 2/ diastolic murmur at left sternal border. CXr shows a widened aortic arch. Dx? - ANSWER✔✔Dissecting aneurysm
QUESTION: 1-week-old girl. screening showed a possible defect in fatty acid oxidation. PE normal. Next step? - ANSWER✔✔Measurement of serum acylcarnitine concentrations QUESTION: 79yoM 30 minutes after LOC for 30 seconds. Alert, but dizzy. No urinary or fecal incontinence. Pulse 40/min, BP 92/56. PE shows no tongue biting. Lungs clear, Variable intensity S1. Oriented X3. ECG shows a third-degree atrioventricular block. Next step? - ANSWER✔✔Insertion of transvenous pacemaker QUESTION: 55yo M with chronic bronchitis in ED after being unresponsive. Found bottles of albuterol, ampicillin, codeine, and theophylline bedside. T 37.2 C, p 112/min, respirations are 6/min, BP 95/60. Acute Rx should include? - ANSWER✔✔naloxone QUESTION: 50yo man has persistent cough for 2 months. He has had a 5 kg (11 lb) weight loss. He is a farmer and on itraconazole 4 weeks for histoplasmosis from chicken coops. Medications: hydrochlorothiazide, enalapril, atenolol, omeprazole, and metoclopramide for hypertension and gastroesophageal reflux. Thin. Physical exam otherwise normal. Itraconazole interacts with which drug and account for lack of effect of itraconazole? - ANSWER✔✔omeprazole QUESTION: 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? - ANSWER✔✔epinephrine
QUESTION: 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? - ANSWER✔✔Breast bud development QUESTION: 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? - ANSWER✔✔25% QUESTION: 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? - ANSWER✔✔Alveolar macrophages QUESTION: 30yo woman 20 weeks gestation, uncomplicated pregnancy. Fundal height is greater than expected for gestational age. Ultrasound shows increased amniotic fluid. Which abnormality is cause? - ANSWER✔✔Tracheoesophageal atresia QUESTION: 43yo woman for health maintenance exam. Physician 30 minutes late for appointment because of emergency, when enters, patients checks watch. Which is best initial
response? - ANSWER✔✔"I'm sorry I got delayed. I hope I haven't made you late somewhere else." QUESTION: 27yo woman 12-hour history of fever and abdominal pain. History of recurrent urinary tract infections. Temperature is 39 C (102.2 F). Physical exam tenderness of right flank. Abdominal xrays bilateral staghorn renal calculi. Urinalysis pH 8, many RBCs, WBC, bacteria. Calculi composed of? - ANSWER✔✔struvite QUESTION: 48yo nulligravid woman with excessive uterine bleeding for 3 months. Bleeding during menses and at irregular intervals. Menses were regular before. BMI 27. Pelvic exam: adnexae are nonpalpable. Endometrial curettage shows abundant tissue. Which is cause of symptoms? - ANSWER✔✔Endometrial hyperplasia QUESTION: 65yo woman surgical repair of aneurysm right internal carotid artery in cavernous sinus. Three days later on physical exam, right pupil larger than left pupil. Weakness of eye movement. Diagram of coronal section through middle cranial fossa shown. Which nerve is damaged? - ANSWER✔✔A (CN III) QUESTION: 55yo woman 6-week history low energy, irritability, crying spells, difficulty falling asleep, wakes up during night, cannot focus. Taking lorazepam for 15y for generalized anxiety disorder. Taking estrogen replacement therapy for postmenopausal symptoms. Vital signs normal. Physical exam normal. Mental status shows constricted affect. Mood is "testy." Speech is slowed. No psychosis. Wishes she wouldn't wake up but doesn't plan to harm herself. Cause of symptoms? - ANSWER✔✔Major depressive disorder
QUESTION: 15yo girl health maintenance exam. Mother dx squamous cell carcinoma face, maternal grandfather died of metastatic melanoma. In patient this age, which factor most predicts compliance with photoprotection? - ANSWER✔✔Use of sunscreen by her peers QUESTION: 34yo AIDS patient with pulmonary tuberculosis. No CD4+ T lymphocytes in peripheral blood. Which cellular components most likely to have deficient function in tuberculous lesions in lungs? - ANSWER✔✔Macrophages QUESTION: 44yo woman follow-up after two Pap smears showing atypical squamous cells of undetermined significant. Test shows viral E6 protein of human papillomavirus. This protein promotes cell growth and malignancy by causing cellular p53 protein degradation. This degradation begins when p53 protein targeted to which type of cell enzymes? - ANSWER✔✔ubiquitin ligase QUESTION: 40yo woman hx of 6 month episodic sinusitis with 2-week intermittent headaches, fatigue, and generalized joint pain, worsening cough productive of blood-tinged sputum. Failed antibiotics, decongestants and nasal corticosteroids. Physical exam: erythema in nasal mucosa, two small ulceration. Lungs scattered crackles. X-ray patchy bilateral opacities. Labs: Hemoglobin 13, ESR 70, leukocyte 10,500, antineutrophil cytoplasmic antibody increased. Dx? - ANSWER✔✔Wegener granulomatosis QUESTION: 25yo woman 6-month history of joint pain poorly responsive to aspirin. Physical exam: bilateral swelling of proximal interphalangeal joints, metacarpophalangeal joints, and
wrists; weakness of grasp. Small nodules palpated beneath skin around joints of fingers. Dx? - ANSWER✔✔Rheumatoid arthritis QUESTION: 50yo woman 1-year hx of hot flashes and irregular menses. Decreased bone mineral density. Alendronate prescribed. Mechanism of drug? - ANSWER✔✔Inhibition of osteoclast-mediated bone resorption QUESTION: Female newborn at 36 weeks gestation has respiratory distress. Apgar 3 and 5 at 1 and 5 minutes. Physical shows cyanosis. Endotracheal and NG tubes placed. Xray shows nasogastric tube in left hemithorax, mediastinum displacement to right, absence bowel gas in abdomen. Which embryological event led to these findings? - ANSWER✔✔Incomplete formation of pleuroperitoneal membrane QUESTION: 65yo women progressive vulva itching past 2 months; miconazole for yeast infections ineffective. Exam: atrophy of labia minora and thin, parchment-like skin over vulva and anus. Dx? - ANSWER✔✔Lichen sclerosus QUESTION: 75yo man 2-day ear ringing, nausea, fatigue. Temp 37 C (98.6 F), pulse 100, respirations 24, bp 140/85. Physical: mild epigastic tenderness. ABG: pH=7.42 pCO2=30 pO2= HCO3=19. Dx? - ANSWER✔✔Salicylate poisoning
QUESTION: 17yo girl 1-day shortness of breath, weakness and muscle tenderness. Did triathlon previous day. BMI 19. Temperature 38 C (100.4 F), respirations 20, bp 150/90. Physical bilateral crackles lower lobes, muscle tenderness. Creatinine 4. Urinalysis 3+ protein, 4+ hemoglobin. Patient's condition is from increased release of which substance? - ANSWER✔✔Myoglobin QUESTION: 16yo boy with no signs of puberty. Sex development Tanner stage 2. Physical exam: circumcised penis, soft small tests 5 mL, prostate firm, nontender, no discharge or lesions. Testosterone low. Which hormone is cause of decreased serum testosterone and lack of pituitary hormone stimulus? - ANSWER✔✔Luteinizing hormone QUESTION: 28yo woman wants to lose weight. She binges on high-carbohydrate foods 2 to 3 times a week, forcing herself to vomit after. BMI 23. Which physical finding is likely? - ANSWER✔✔Parotid gland enlargement QUESTION: 15yo girl emigrated from India and with several lesions on neck for 2 weeks. Physical exam shows hypopigmented, hypoesthetic area on left side of forehead and 4-cm lesions on neck. Biopsy shows acid-fast bacilli. Best explanation why the organism results in dermal rather than visceral infections? - ANSWER✔✔Temperature sensitivity QUESTION: 59yo man has total thyroidectomy for 4-cm follicular carcinoma of thyroid. Twelve hours after procedure, has paresthesias of hands and feet. Vitals stable, carpal spasm on inflammation of bp cuff. Lab findings? - ANSWER✔✔Decreased parathyroid hormone, decreased calcium
QUESTION: 41yo man with asthma and allergy to grass pollen wheezes and difficulty breathing 10 min after mowing lawn. Drug for immediate relief of acute symptoms? - ANSWER✔✔Albuterol QUESTION: 14yo boy daily headaches for 2 months. Headaches are bilateral aching in temples. "Has not been himself" for months. Confused, forgetting names, dates, places, clumsy, frequent falls. School performance declined. Physical exam: broad-based ataxic gait. Slow to answer questions. Chronic abuse of which substance? - ANSWER✔✔Inhaled glue QUESTION: 40yo African American woman 2-week hx fever, malaise, dyspnea. Temperature 36.7 C (98 F), respirations 20. Physical exam: erythema nodosum, parotid enlargement, hepatosplenomegaly. Calcium 16. CT chest bilateral hilar adenopathy. Increase of which in serum? - ANSWER✔✔1,25-Dihydroxycholecalciferol QUESTION: 56yo woman with restrictive cardiomyopathy, proteinuria, renal failure. 35-year history of rheumatoid arthritis. Renal biopsy shows glomerular deposition of eosinophilic hyaline material. Congo red stain: birefringent pattern under polarized light. Structure of material? - ANSWER✔✔beta-pleated sheet structure QUESTION: 63yo man 3-month hx difficulty sleeping. Sleeps better upright. HR 90, bp 110/60. Physical exam: increased jugular venous pressure, mild ankle edema. Cause of edema? - ANSWER✔✔Increased capillary hydrostatic pressure
