2022 NBME NEW TEST COMPILATION with verified Answers

2022 NBME NEW TEST COMPILATION with verified Answers A 1 month old - male newborn is brought to the physician for a routine examination. Parents have dark skin and eyes. PE shows hypopigmentation of the skin, light blonde hair, and translucent irises. The inherited disorder causes this phenotypic expression is most likely due to a defect in the metabolism of which? -Answer= Tyrosine albinism, which is due to decreased tyrosinase activity. If he has a problem metabolizing Phenylalanine, he would be presenting with the PKU sx like intellectual disability, musty body odor, etc., in addition to his fair complexion A 55-year-old - 2 weeks history of palpitations and anxiety. He has primary hypothyroidism and treated with Levothyroxine. Pt is taking 2x dosage of Levothyroxine for 2 months. Which are most likely set of findings? -Answer= Increased Free T4 Increased Free T3 Decreased Thyroid Iodine Uptake the patient has been taking excess of his levothyroxine medication. Levothyroxine is the exogenous form of T4. Therefore, free T4 must be elevated. T4 is converted to T3 at most peripheral tissues, so T3 will also be elevated. 12-year-old boy - brought to the physician by his mother for a well-child exam. His mother has outgrown the clothes that she bought him 6 months ago. 50th percentile for height and weight. Pt shows growth of 2.3 in/year. PE shows mild acne. Pubic hair and testes development are Tanner stage 2. Cause of onset of physical changes in this patient? -Answer= Nocturnal Luteinizing Hormone Pulses Gonadotropin pulses occur only during sleep, but as puberty progresses they can be detected during the day. By the end of puberty, there is little day-night difference in the amplitude and frequency of gonadotropin pulses. A 23-year-old primgravid woman at 22 weeks gestation is brought to a small rural hospital by her husband becase of intermittent bleeding during past week. Pt woke up in copius amounts of blood and BP 90/60 mm/Hg. Her female obstetrician is a woman who practices 2 hours away. Pt is a conservative muslin and dressed in a burka, and she doesn't want a male physician. Only physician available is a male. Which of the following is the most appropriate action by the physician? - Answer= Ask the patient if she would allow the examination if her husband is present at all times Patient needs medical attention immediately, which eliminates obtaining a court order, or transferring her. A nurse does not have the same training and qualifications as a physician best option among those given is to ask the patient if she will allow with her husband present. A 43 year old woman - nonproductive cough for 3 weeks. She has 6.8 kg (15 lb) weight loss. A CXR shows 3 nodules in right lung. FNA suggest a malignant neoplasm. A photograph in the patient is shown. Which of the following is most likely diagnosis -Answer= Metastatic Carcinoma metastasis was the best option here because there are multiple malignant neoplasms A 62-year-old man - comes to physician for a follow-up exam. One month ago, he was prescribed a proton pump inhibitor (PPI) for epigastric pain that relieved when he easts. Pt states that the symptoms are still present and cause discomfort. Serum studies shows gastrin 4x reference range. Physician discontinues the PPI therapy in this patient. 3 weeks later, most appropriate to measure the concentration of which? -Answer= Serum Gastrin The use of any agent that inhibits gastric secretion of acid rule out Zollinger-Ellison syndrome you need to stop the PPIs first, then measure Gastrin to make that your intial measure of elevated Gastrin was not due to your drug rather than the patients disease. 62 year old woman - osteoporosis - a bisphosphonate is prescribed. The expected beneficial effect of the drug is due to which of the following? -Answer= 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? -Answer= 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? - Answer= 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? -Answer= 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? -Answer= 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? -Answer= 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? -Answer= 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? -Answer= Infectious Mononucleosis