NBME CBSE BASIC SCIENCE
EXAMINATION PREP GUARANTEED TO
PASS
◉ 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: 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
◉ 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, 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/ 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
, ◉ 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?
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?
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?
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?
Answer: Breast bud development
EXAMINATION PREP GUARANTEED TO
PASS
◉ 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: 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
◉ 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, 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/ 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
, ◉ 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?
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?
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?
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?
Answer: Breast bud development
