NBME CBSE
ACTUAL TEST
Q&A
USMLE STEP 1
, NBME CBSE ACTUAL TEST QUESTIONS AND
g g g g g
ANSWERS (Quiz bank with all the correct answers) (usmle s
g g g g g g g g g
tep 1) Medical examination
g g g
62gyeargoldgwomang-gosteoporosisg-
gagbisphosphonategisgprescribed.gThegexpectedgbeneficialgeffectgofgthegdruggisgduegtogwhic
hgofgthegfollowing?g-Answer-gDecreasedgOsteoclastgActivity
CohotgStudygofgelderlygwomeng-
grelativegriskgratiogforghipgfracturesgamonggthosegwhogexercisegregularlygisg1.2g(95%gconfide
ncegintervalgofg1.1gtog1.8).gWhichgofgthegfollowinggisgthegconclusiongaboutgthegeffectgofgexerc
isegongthegriskgofghipgfracture?g-Answer-gStatisticallygSignificantgOverallgIncreasegRisk
52gyeargoldgmanggoesgtogERgwithgchestgpaingradiatinggtoghisgjawgwhilegshovelinggsnow.gPu
lsegisg80/mingandgbloodgpressuregisg130/70.gThegmostgimmediategtreatmentgmechanismgo
fgaction?g-Answer-gIncreasedgnitricgoxidegconcentration
24gyeargoldgwomang-gspilledghotggreasegonghergleftgleggwhilegworkinggatgagfast-
foodgrestaurant.gExamgofgleggshowsg7cmgpink,gsoft,ggranular,gedematousgwound.gThegform
ationgofgthisgtissuegwasgmostglikelygcausedgbygincreasedgactivitygofgwhich?g-Answer-
a. VasculargEndothelialgGrowthgFactorg
VEGFg-gstimulatesgangiogenesiss.
TYPEgIIIgCollageng=gBloodgVesselsg-gearlygwoundgrepair
27gyeargoldgman-gMVCg-gskullgx-raygshowsgaglinear,gnondepressedgbasalgskullgfractureg-
gincreasedgserumgosmgandgdecreasedguringosm.gFollowinggdesmopressingurinegosmgincr
eases.gDesmopressin'sgeffectgisgduegtogthegactivationgofgwhichgofgthegfollowing?g-
gAnswer-ga.gAdenylylgCyclase
gAdenylategCyclaseg-gATPg-gCAMPg--gPROTEKINASEgAg--gCagv2
Ag10gmonthgoldgboyg-
g4gdayghistorygofgfevergandgcough.gHegattendsgdaygcaregcenter.gChestgexamgshowsginterc
ostalgretractionsgalonggwithgbilateral,gdiffusegwheezesgandgexpiratorygrhonchi.gTheginfecti
ousgagentgmostglikelyghasgwhichgofgthegfollowinggproperties?g-Answer-
gMediationgofgCellgEntrygviagagfusiongprotein
Ag17gyeargoldggirlgingEDg-
g15gminutesgaftergbeinggstunggbygagbee.gMildglightgheadednessgbutgnogdifficultygswallowing-
gBilateralgwheezingg-gWhichgisgmostgappropriategpharmacotherapygforgthisgpatient?g-
Answer-gB2-gAgonist
14gyeargoldgboyg-
g2gdayghistorygofgsoregthroatgandgfevergthatgpeaksginglategafternoon.g1gweekgofgfatigue.gHegre
centalyghadgsexgwithgonegpartner.gPhysicalgexamgshowgcervicalglymphadenopathygandgpha
ryngealgerythemagwithgagcreamygexudate.gDX?g-Answer-gInfectiousgMononucleosis
,57gyeargoldgmang-
gradiationgtherapygforgsquamousgcellgcarcinomagofgtheglung.gDespitegtherapy,gtumorgincre
asesgingsizegandghegdiesg6gmonthsglater.gThegprogressivegtumorggrowthgisgduegtogagdefectg
ingcellgcyclegarrestgingwhichgofgthegfollowinggphasesgofgcellgcycle?g-Answer-gG1
28gyeargoldg-glivedgingsub-SaharangAfricag-guntilghegcamegtogthegUS.gTempgofg100.4g-
gimaginggshowsgbilateralghydrouretergandghydronephrosis.gBiopsygshowsgmarkedgfibrosisga
ndgscatteredggranulomas.gDX?g-Answer-gSchistosomiasis
Agcouplegwithgagfamilyghistorygofga-
thalassemia.gWomanghasgoneggenegdeletiongandgmanghasgtwoggenegdeletion.gIfgthegtwogge
negisgtransg-gwhatgpercentagegofgoffspringgwillghavegagtwoggenegdeletion?g-Answer-g50%
previouslyghealthyg40gyeargbroughtgtogemergencygdepartmentgbygherghusbandg-
g2gdayghistorygofgfever,glethargy,gconfusion.gPEgshowsgscatteredgpetechiaegandgecchy
mosesgovergtheglowergextremitiesg-
g3+gpolychromasiagandg3+gschistocytesgandgLowgplateletsgDx?g-Answer-
gThromboticgThrombocytopeniagPurpura
16gyeargoldgboyg-
gisgadmittedgtogthegERgbecausegofgagknifegwoundgtogthegleftgsidegofghisgchest.gAngX-
raygofgthegchestgshowsgangair-
fluidglevelgingthegleftgsidegofgthegchest,gpartialgcollapsegofgthegleftglung,gandgthegelevationg
ofgthegstomachgbubble.gThegmediastinumgisgmidline.gDX?g-Answer-
gHemopneumpothoraxgundergtension
49gyeargoldgwomang-gcoronarygarterygdiseaseg-gBPg140/90g-
gHighgCholesterol,gHighgLDLg(190),gHighgtriglyceridesg(350)g-
gTXgwithgatorvastatingandglosartan.gWhatgaregthegeffectsgongHDLgandgTriglycerides?g-
Answer-gHDLgincreased
TriglyceridesgDecreased
73gyearegoldg-
gdiffusegweaknessgandgtinglinggofghergarmsgandglegs.gSensationgandgvibrationgandgpositiong
isgdecreasedgingallgextremities.gWhatgvitamingdeficiency?g-Answer-gVitamingB12g-
g(cyanocobalamin)
TeagandgToastg-glowgB12gingdiet
15gyeargoldggirlg-g3gmonthghistorygofgacneg-
gwhichgisgthegunderlyinggcausegofgthegpatientsgacne?g-Answer-
gStimulationgofgSebaceousgGlandsgbygandrogens
b. ACNEg=gPropionibacteriumgACNE
4gyeargoldgfromgBrazilg-
gPEgshowsgsingleg12x10cmglesiongingthegrightgsidegofgjawgwithgdiffusegregulargedges.gPhoto
micrographsgofgangincisionalgbiopsyg(looksglikegBurkittsgLymphoma/gStarrygnight)g-
gwhichgofgthegprocessesgmostglikelygtogoccurgingthegregiongindicatedgbygthegarrow?g-
Answer-gApoptosis
b.gEndemicgBurkittglymphomagcanghappengingBrazilgasgwellgasgAfricag(jawglesion,gpuffygfac
e).
, 51gyeargoldg-glumpgongtongueg-
g1gpackgsmokingghistorygforg30gyears.g1.5gcmgmassgongapexgofgtongue.gItgisgmostgappropri
ategtogevaluategwhichglymphgnodesgfirstgforgevidencegofgmetastasis?g-Answer-
gSubmental
15gyeargoldgboyg-gERg-g2ghourghistorygofgconfusiongandgagitationg-
gfever,gheadache,gstiffgneck,gandgvomitingg-gsincegreturnedgfromgsummergcampg-
gpatientgisghallucinatingg-glumbargpunctureg-gshowsgcystsgandgtrophozoites-
gmostglikelygpathogen?g-Answer-ga.
OlfactorygNerveg
Naegleriagfowleri
17gyeargoldg-gEDg-
g30gminutesgaftergbeinggfoundgwithgagblankgstare.gPhysicalgexamgshowsgrigidity.gDuringgexa
mghegbecomesghostilegandgassaultsgphysiciang-gPtgingestedgwhichgdrug?g-Answer-gPCP
Placebogcontrolledgclinicalgtrialg-
g5000gptsgwithgessentialghypertension.g2500gpatientsgreceivegnewgdruggandg2500gpatientsgr
eceivegplacebo.gIfgalphagisgsetgatg0.01ginsteadgofg0.05,gwhichgofgthegfollowinggisgmostglikelygr
esult?g-Answer-gSignificantgfindingsgcangbegreportedgwithggreatergconfidence
17gyeargoldg-ggymnastg-
gcomesgtoghospitalgbecausegofglackgofgmenstrualgperiodgforg6gmonths.gBMIg15gWhichgisgtheg
causegofgthegamenorrhea?g-Answer-gHypogonadotropicgHypogonadism
Agmalegstillborngisgdeliveredgatg32gweeksg-gOligohydramniosg-
gabsencegofgagurethralgopening.gWhichgisgmostglikelygfinding?g-Answer-
gPulmonarygHypoplasia
Ag6gdaygoldg-gbreastgfedgboygingEDg-gpoorgweightggaingandgirritabilitygsincegdeliveryg-
gPhysicalgexamgshowsgjaundicegandghepatomegaly.gThegconcentrationgofgwhichgofgthegfoll
owinggmetabolitesgisgmostglikelygincreased?g-Answer-ga.gGalactoseg-g1g-gphosphate
b.gCongenitalgintolerancegtogbreastgmilk
Ag25-year-oldgmang-gcomesgtogEDg-
gseveregmusclegpain,gdiffuse,gpainfulgswellinggofghisgneck,gunderarms,gandggroingaftergcamp
inggingNewgMexicogGeneralizedgscatteredgblackgmaculae.gExaminationgofgthegrightgupperge
xtremitygshowsgerythematous,gsolid,gtendergmass.gMassgisgdraininggbloodgandgnecroticgma
terial.gThegmostgeffectivegantibioticgforgpatientgdisordergwillginterferegwithgwhichgofgthegfollo
winggprocesses?g-Answer-ga.
RibosomalgAssembly
b.gYerseniagPestis
45gyeargoldg-gprogressivegweaknessg-
gmusclegfasciculationsgofgtheguppergextremitiesgandgweaknessgofgtheglowergextremityg-
gWhatgadditionalgfindings?g-Answer-gAtrophy
b.gALSg=gLougGherig
Agnewgseveregrespiratorygillnessg-gWhygusegagkilledgvaccinegvsgaglivegvaccine?g-Answer-
AvoidsgConcernsgofgreversiongtogvirulence
b.gKilledgvaccinesg-gavoidsgreversiongtogvirulence
ACTUAL TEST
Q&A
USMLE STEP 1
, NBME CBSE ACTUAL TEST QUESTIONS AND
g g g g g
ANSWERS (Quiz bank with all the correct answers) (usmle s
g g g g g g g g g
tep 1) Medical examination
g g g
62gyeargoldgwomang-gosteoporosisg-
gagbisphosphonategisgprescribed.gThegexpectedgbeneficialgeffectgofgthegdruggisgduegtogwhic
hgofgthegfollowing?g-Answer-gDecreasedgOsteoclastgActivity
CohotgStudygofgelderlygwomeng-
grelativegriskgratiogforghipgfracturesgamonggthosegwhogexercisegregularlygisg1.2g(95%gconfide
ncegintervalgofg1.1gtog1.8).gWhichgofgthegfollowinggisgthegconclusiongaboutgthegeffectgofgexerc
isegongthegriskgofghipgfracture?g-Answer-gStatisticallygSignificantgOverallgIncreasegRisk
52gyeargoldgmanggoesgtogERgwithgchestgpaingradiatinggtoghisgjawgwhilegshovelinggsnow.gPu
lsegisg80/mingandgbloodgpressuregisg130/70.gThegmostgimmediategtreatmentgmechanismgo
fgaction?g-Answer-gIncreasedgnitricgoxidegconcentration
24gyeargoldgwomang-gspilledghotggreasegonghergleftgleggwhilegworkinggatgagfast-
foodgrestaurant.gExamgofgleggshowsg7cmgpink,gsoft,ggranular,gedematousgwound.gThegform
ationgofgthisgtissuegwasgmostglikelygcausedgbygincreasedgactivitygofgwhich?g-Answer-
a. VasculargEndothelialgGrowthgFactorg
VEGFg-gstimulatesgangiogenesiss.
TYPEgIIIgCollageng=gBloodgVesselsg-gearlygwoundgrepair
27gyeargoldgman-gMVCg-gskullgx-raygshowsgaglinear,gnondepressedgbasalgskullgfractureg-
gincreasedgserumgosmgandgdecreasedguringosm.gFollowinggdesmopressingurinegosmgincr
eases.gDesmopressin'sgeffectgisgduegtogthegactivationgofgwhichgofgthegfollowing?g-
gAnswer-ga.gAdenylylgCyclase
gAdenylategCyclaseg-gATPg-gCAMPg--gPROTEKINASEgAg--gCagv2
Ag10gmonthgoldgboyg-
g4gdayghistorygofgfevergandgcough.gHegattendsgdaygcaregcenter.gChestgexamgshowsginterc
ostalgretractionsgalonggwithgbilateral,gdiffusegwheezesgandgexpiratorygrhonchi.gTheginfecti
ousgagentgmostglikelyghasgwhichgofgthegfollowinggproperties?g-Answer-
gMediationgofgCellgEntrygviagagfusiongprotein
Ag17gyeargoldggirlgingEDg-
g15gminutesgaftergbeinggstunggbygagbee.gMildglightgheadednessgbutgnogdifficultygswallowing-
gBilateralgwheezingg-gWhichgisgmostgappropriategpharmacotherapygforgthisgpatient?g-
Answer-gB2-gAgonist
14gyeargoldgboyg-
g2gdayghistorygofgsoregthroatgandgfevergthatgpeaksginglategafternoon.g1gweekgofgfatigue.gHegre
centalyghadgsexgwithgonegpartner.gPhysicalgexamgshowgcervicalglymphadenopathygandgpha
ryngealgerythemagwithgagcreamygexudate.gDX?g-Answer-gInfectiousgMononucleosis
,57gyeargoldgmang-
gradiationgtherapygforgsquamousgcellgcarcinomagofgtheglung.gDespitegtherapy,gtumorgincre
asesgingsizegandghegdiesg6gmonthsglater.gThegprogressivegtumorggrowthgisgduegtogagdefectg
ingcellgcyclegarrestgingwhichgofgthegfollowinggphasesgofgcellgcycle?g-Answer-gG1
28gyeargoldg-glivedgingsub-SaharangAfricag-guntilghegcamegtogthegUS.gTempgofg100.4g-
gimaginggshowsgbilateralghydrouretergandghydronephrosis.gBiopsygshowsgmarkedgfibrosisga
ndgscatteredggranulomas.gDX?g-Answer-gSchistosomiasis
Agcouplegwithgagfamilyghistorygofga-
thalassemia.gWomanghasgoneggenegdeletiongandgmanghasgtwoggenegdeletion.gIfgthegtwogge
negisgtransg-gwhatgpercentagegofgoffspringgwillghavegagtwoggenegdeletion?g-Answer-g50%
previouslyghealthyg40gyeargbroughtgtogemergencygdepartmentgbygherghusbandg-
g2gdayghistorygofgfever,glethargy,gconfusion.gPEgshowsgscatteredgpetechiaegandgecchy
mosesgovergtheglowergextremitiesg-
g3+gpolychromasiagandg3+gschistocytesgandgLowgplateletsgDx?g-Answer-
gThromboticgThrombocytopeniagPurpura
16gyeargoldgboyg-
gisgadmittedgtogthegERgbecausegofgagknifegwoundgtogthegleftgsidegofghisgchest.gAngX-
raygofgthegchestgshowsgangair-
fluidglevelgingthegleftgsidegofgthegchest,gpartialgcollapsegofgthegleftglung,gandgthegelevationg
ofgthegstomachgbubble.gThegmediastinumgisgmidline.gDX?g-Answer-
gHemopneumpothoraxgundergtension
49gyeargoldgwomang-gcoronarygarterygdiseaseg-gBPg140/90g-
gHighgCholesterol,gHighgLDLg(190),gHighgtriglyceridesg(350)g-
gTXgwithgatorvastatingandglosartan.gWhatgaregthegeffectsgongHDLgandgTriglycerides?g-
Answer-gHDLgincreased
TriglyceridesgDecreased
73gyearegoldg-
gdiffusegweaknessgandgtinglinggofghergarmsgandglegs.gSensationgandgvibrationgandgpositiong
isgdecreasedgingallgextremities.gWhatgvitamingdeficiency?g-Answer-gVitamingB12g-
g(cyanocobalamin)
TeagandgToastg-glowgB12gingdiet
15gyeargoldggirlg-g3gmonthghistorygofgacneg-
gwhichgisgthegunderlyinggcausegofgthegpatientsgacne?g-Answer-
gStimulationgofgSebaceousgGlandsgbygandrogens
b. ACNEg=gPropionibacteriumgACNE
4gyeargoldgfromgBrazilg-
gPEgshowsgsingleg12x10cmglesiongingthegrightgsidegofgjawgwithgdiffusegregulargedges.gPhoto
micrographsgofgangincisionalgbiopsyg(looksglikegBurkittsgLymphoma/gStarrygnight)g-
gwhichgofgthegprocessesgmostglikelygtogoccurgingthegregiongindicatedgbygthegarrow?g-
Answer-gApoptosis
b.gEndemicgBurkittglymphomagcanghappengingBrazilgasgwellgasgAfricag(jawglesion,gpuffygfac
e).
, 51gyeargoldg-glumpgongtongueg-
g1gpackgsmokingghistorygforg30gyears.g1.5gcmgmassgongapexgofgtongue.gItgisgmostgappropri
ategtogevaluategwhichglymphgnodesgfirstgforgevidencegofgmetastasis?g-Answer-
gSubmental
15gyeargoldgboyg-gERg-g2ghourghistorygofgconfusiongandgagitationg-
gfever,gheadache,gstiffgneck,gandgvomitingg-gsincegreturnedgfromgsummergcampg-
gpatientgisghallucinatingg-glumbargpunctureg-gshowsgcystsgandgtrophozoites-
gmostglikelygpathogen?g-Answer-ga.
OlfactorygNerveg
Naegleriagfowleri
17gyeargoldg-gEDg-
g30gminutesgaftergbeinggfoundgwithgagblankgstare.gPhysicalgexamgshowsgrigidity.gDuringgexa
mghegbecomesghostilegandgassaultsgphysiciang-gPtgingestedgwhichgdrug?g-Answer-gPCP
Placebogcontrolledgclinicalgtrialg-
g5000gptsgwithgessentialghypertension.g2500gpatientsgreceivegnewgdruggandg2500gpatientsgr
eceivegplacebo.gIfgalphagisgsetgatg0.01ginsteadgofg0.05,gwhichgofgthegfollowinggisgmostglikelygr
esult?g-Answer-gSignificantgfindingsgcangbegreportedgwithggreatergconfidence
17gyeargoldg-ggymnastg-
gcomesgtoghospitalgbecausegofglackgofgmenstrualgperiodgforg6gmonths.gBMIg15gWhichgisgtheg
causegofgthegamenorrhea?g-Answer-gHypogonadotropicgHypogonadism
Agmalegstillborngisgdeliveredgatg32gweeksg-gOligohydramniosg-
gabsencegofgagurethralgopening.gWhichgisgmostglikelygfinding?g-Answer-
gPulmonarygHypoplasia
Ag6gdaygoldg-gbreastgfedgboygingEDg-gpoorgweightggaingandgirritabilitygsincegdeliveryg-
gPhysicalgexamgshowsgjaundicegandghepatomegaly.gThegconcentrationgofgwhichgofgthegfoll
owinggmetabolitesgisgmostglikelygincreased?g-Answer-ga.gGalactoseg-g1g-gphosphate
b.gCongenitalgintolerancegtogbreastgmilk
Ag25-year-oldgmang-gcomesgtogEDg-
gseveregmusclegpain,gdiffuse,gpainfulgswellinggofghisgneck,gunderarms,gandggroingaftergcamp
inggingNewgMexicogGeneralizedgscatteredgblackgmaculae.gExaminationgofgthegrightgupperge
xtremitygshowsgerythematous,gsolid,gtendergmass.gMassgisgdraininggbloodgandgnecroticgma
terial.gThegmostgeffectivegantibioticgforgpatientgdisordergwillginterferegwithgwhichgofgthegfollo
winggprocesses?g-Answer-ga.
RibosomalgAssembly
b.gYerseniagPestis
45gyeargoldg-gprogressivegweaknessg-
gmusclegfasciculationsgofgtheguppergextremitiesgandgweaknessgofgtheglowergextremityg-
gWhatgadditionalgfindings?g-Answer-gAtrophy
b.gALSg=gLougGherig
Agnewgseveregrespiratorygillnessg-gWhygusegagkilledgvaccinegvsgaglivegvaccine?g-Answer-
AvoidsgConcernsgofgreversiongtogvirulence
b.gKilledgvaccinesg-gavoidsgreversiongtogvirulence
