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NBME CBSE REAL EXAM 200
QUESTIONS AND ANSWERS LATEST
2025 COMPLETE EXAM (usmle step
1)MEDICAL EXAMINATION
70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult blood in the stool. Photo of transverse colon shown. Dx? - Answer--Tubular adenoma or villous polyp. GI blood loss suggests a risk for malignancy
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 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? - Answer--Failure to distinguish between statistical significant and clinical significance
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."
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? - Answer--LAD
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-ray of SI 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? - 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? - 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? - Answer--ESR is not sensitive; need additional testing like a biopsy to confirm the diagnosis
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
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. T 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--> progresses more slowly and is only seen in a few West African countries
28yo F G1P1 with 2-day history of a painful mass in her right breast. Delivered healthy female newborn 3 weeks ago, and been breast0-feeding since. T 37C, PE shows 3-cm tender mass surrounded by an area of erythema beneath the right areola. Causal org? - Answer--S. 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? - Answer--IL-
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? - Answer--Gonorhhea
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 endo crine structure? - Answer--ADH--> posterior pituitary
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
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 LES
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--Pseudomembranes of fibrin and inflammatory debris
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. 2/6 diastolic murmur at left sternal border. CXr shows a widened aortic arch. Dx? - Answer--Dissecting aneurysm
1-week-old girl. screening showed a possible defect in fatty acid oxidation. PE normal. Next step? - Answer--Measurement of serum acylcarnitine concentrations
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? - Answer--Chronic bronchitis--> increased PaCO2--> to compensate, increase HCO3-
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? - Answer--Admit the patient 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? - Answer--Vasodilation of the afferent arteriole
83yo M brought to ED after being found at home bedridden and confused. No meds. P 100/min, BP 85/50. BP unchanged after 1L IV saline. Pulmonary artery catheter shows: Cardiac output high, PCWP low, systemic vascular resistance low. Cause of hypotension? - Answer--Early septic shock (only form with decreased SVR)
32yo M with 3-month hx of swelling and breast tenderness. Receiving thyroid hormone and steroid replacements since removal of pituitary adenoma 2 years ago. Began hCG injections 4 months ago. Most likely binding site of hCG causing gynecomastia? - Answer--Acts on testes and leads to increased estrogen
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? - Answer--Loratadine--> less sedating antihistamine
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
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 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 postconception (in days)? - Answer--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? - 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? - 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? - Answer--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? - Answer--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? - Answer--EBV
24yo M with hx of IVDA could not be aroused. Friend reports that the pati ent 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--= 200 (0.3) =
3 half-lives = 120, 240, 480
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
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? - Answer--Scrotum
Corresponded to penis shaft? - Answer--Labia minora
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 tw groups. Design? - Answer--RCT
12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological changes?
ADH:
Central Blood volume:
ANP: - Answer--ADH: decreased (VC leads to decreased ADH)
ANP: increased
Central blood volume: increased
68yo M with 6-month hx of erectile dysfunction. PE and labs normal. If pharmacotherapy is indicated, drug with which MOA? - Answer--PDE inhibitor
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? - Answer--Kartageners
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. Fetahl heart sounds are heard. WBC 12K, Blood cultures grow gram-positive rods. Causal organism? - Answer--Listeria
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? - Answer--Pemphigus; antibodies 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? - Answer--Hypocalcemia
52yo F with hot flashes. Menses have been irregular for the past 6 months. Physiologic cause? - Answer- -Lack of ovaries to secrete 17B-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 tenderness with guarding in left lower quadrant. Cervical os is closed. serum beta-hCG is 6000. U/S shows empty uterus. Dx? - Answer--Ectopic pregnancy
26yo F 5 weeks after birth of first child. Worries constantly that the infant is ill and wakes up to make sure he is well. Washes her hands 30 times per day. Worried about people braking into her house, checks lock 3-4 times a night. Not breast feeding. Rx? - Answer--SSRI (sertraline)
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
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
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 (CYP P450 inhibitor)
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, HCO 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/ glucagon--> triggers FA breakdown to create glucose
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? - 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? - Answer--Increased hydrostatic pressure in Bowman's space
34yo woman with pyelonephritis treated with bactericidal antibiotic 4 days no improvement. Antibiotic added that inhibits binding to 30S ribosome, blocking protein synthesis intracellularly. Antibiotic? - Answer--Gentamicin
3yo boy and his 5yo brother with recurrent hemarthroses. Both parents healthy, but mother with two younger brothers with same sx and maternal uncle who died at 8 of mild head trauma. Partial thromboplastin time is prolonged. Defect? - Answer--Factor VIII
6yo boy from Russia with unstable gait and incoordination for 2 weeks. Pale, bulky stools for 4 years and two episodes of bacterial pneumonia and chronic cough since age 1 year. 3%ile for height/weight. Neuro exam shows ataxia, no DTRs, loss of proprioception. Stool shows inc fat concentration. Vitamin deficient? - Answer--Vitamin E
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? - Answer--Myxoma (most commonly appear in the LA)
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? - 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? - Answer--Nephrolithiasis
56yo F follow-up 8 weeks after recovering from pneumococcal pneumonia. Chest X-rays normal. Which allowed this resolution to occur? - Answer--Maintenance of the BM 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? - Answer--TSH: decreased
Free thyroxine: decreased (measure of T4--> decreases when T3 increase)
Free triidothyronine: increased (T3)
20yo F has multiple neurofibromas. Mom, uncle, and brothers with similar lesions. Mode of inheritance?
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? - Answer--Mallory hyaline--> alcoholic hepatitis
10yo boy has had anemia since birth. Spleen is five times normal. Splenectomy is indicated if anemia is caused by which? - Answer--Hereditary spherocytosis
62yo F in ED for 2-day hx of fever, abdominal tenderness, and painful urination. Agitated. T 38.8C, Labs show WBC 14k. Admitted to hospital, nurses note she has torn up four breakfast menus because she is confused. Cause? - Answer--Delirium
60yo F with 3-year Hx of hyperlipidemia. Low-cholesterol diet and exercise program ineffective after 1 year. Lovastatin initiated, but unable to tolerate greater than 20 mg daily. Additional drug is added that inhibits transport of cholesterol through intestinal wall. Which drug? - Answer--Ezetimibe
48yo M with bronzing of his skin, weakness, and fatigue during the past 3 months. PE shows hepatomegaly, and small testes. Serum: AST INCREASED, ALT INCREASED, iron INCREASED, transferrrin sat INCREASED, ferritin INCREASED, testosterone DECREASED, LH DECREASED, FSH DECREASED. Explaination? - Answer--Hemochromatosis--> increased intestinal iron absorption
57yo M with alcoholism has distended abdomen with shifting dullness, fluid wave, caput medusae, palmar erythema, spider angiomata. Additional finding? - 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 noreipinephrine and marked increase in dopamine concentration when standing. Deficiency of which? - Answer--DA-B-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? - Answer--T
60yo M from china to USA with 1-month hx of confusion and swelling of abdomen and legs. Peanut farmer in china. Smoked 1 pack per day for 40 years. No alcohol. PE shows ascites and ankle edema. Liver palpable, spleen isn't.
Serum: Albumin 4, total bili 2.5, Alk Phos 200, AST 45, ALT 60, IgG anti Hep A positive; Anti hep B negative, anti hep C negative.
U/S shows 10 cm lesion. Biopsy shows dysplastic hepatocytes in small clusters and rows with no normal architecture. Exposure to which? - Answer--Aflatoxin
42yo M in ED for 5-hour hx of fever, chills, and severe pain and swelling of his left arm. Scratched his arm on a nail yesterday. Appears confused, T 40C, BP 71/38. Labs show Hb 14, HCt 42%, WBC 15K (35% PMNs, 40% bands, 25% lymphos), Platelets 50K, Serum BUN 28, Cr 2.8. Symptoms due to systematic release of which cytokines? - Answer--Septic shock--> IL-1 and TNF-alpha
62yo M dies suddenly while playing tennis. No cardiac risk factors, no hx of CAD. Autopsy, cardiac valve defect and concentric LVH. Which valve abrnomalities is most likely involved? - Answer--AS
67yo M has urinary urgency after placement of urinary bladder catheter during transurethral resection of the prostate. Most appropriate Rx has which MOA? - Answer--Urinary urge incontinence--> Oxybutinin--> M3 R antagonist
Mouse embryos are produced with two pronuclei, both of same parental origin. When the pronuclei are maternal, produces have poorly developed extraembryonic structures. When both pronuclei are paternal, produces have poorly developed embryonic tissue. Which genetic mechnanisms? - Answer-- Imprinting
18-yo F with sepsis after an abortion. Within 24 hours she becomes dyspneic, oliguric, and develops petechiae, ecchymoses, and bleeding from venipuncture sites. Which lab finding? - Answer--DIC--> decreased fibrinogen
63yo M with 6-month hx of exertional chest pain relieved by rest. smoked for 45 years. Mild HTN, no meds. Which lesion in LAD is most likely cause? - Answer--Calcified 80% stenosis
65yo F with ovarian cancer treated with cyclophosphamide and other chemotherapeutic agents. Cyclophosphamide affects which target? - Answer--DNA replication
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*4 alleles. Likelihood patient's sisters has same alleles? - 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? - Answer--Alveolar macrophages
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--TEF
34yo man lightheaded after running 12 miles of marathon hot day. Pulse 130 bp 80/60. Which changes to autonomic nervous system occurred? - Answer--Increased SNS, decreased PNS--> orthostatic hypotension
6-Mercaptopurine (6-MP) used to treat acute lymphoblastic leukemia (ALL). 6-MP acted on by enzymes to make 6-thioguanine nucleotides (6-TGN). Efficacy and toxicity of 6-MP correlated with 6-TGN. 6-MP acted on by xanthine oxidase (XO), thiopurine methyltransferase (TPMT), leading to inactive metabolites. Which are clinical consequences of ALL patients homozygous for low-activity alleles of TPMT? - Answer--Give decreased doses of 6-MP--> slow metabolizer
Ten human subjects given new oral drug to monitor drug effect and toxicity. Blood analyzed for human pharmacokinetics of drug for first time. Which trial type? - Answer--Type I
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 peers
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
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 beings when p53 protein targeted to which type of cell enzymes? - Answer--Ubiquitin ligase
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 nasal mucosa, two small ulceration. Lungs scattered crackles. Xray patchy bilateral opacicites. Labs: Hemoglobin 13, ESR 70, leukocyte 10,500, antineutrophil cytoplasmic antibody increased. Dx? - Answer--GPA
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--RA
50yo woman 1-year hx of hot flashes and irregular menses. Decreased bone mineral density. Alendronate prescribed. Mechanism of drug? - Answer--Inhibits osteoclasts
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 (diaphragmatic hernia)
65yo women progressive vulvar 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 sclerosis
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 95 HCO3 19. Dx? - Answer--Respiratory alkalosis; salicylate poisoning
15yo girl 1-day hx redness and painful skin following sunbathing. She used sunblock. No medications. Physical exam: severe erythema of back and extremities, no blisters. Dx? - Answer--1st-degree burn
58yo man supraventricular tachyarrhythmia refractory to pharmacotherapy gets ablation of accessory excitatory pathway in atrial endocardium. Which area should be avoided to leave sinoatrial (pacemaker) node intact? - Answer--The junction of t he SVC and RA
81yo woman massive pulmonary embolism from deep venous thrombosis. Platelet count 160,000. Appropriate pharmacotherapy is started. One week later, platelets 55,000. Thrombocytopenia most likely caused by a drug with which of the following mechanism of action? - Answer--Potentiates the action of AT III
