NBME Practice Questions And Answers
2022 Test Bank Latest
A 67-year-old woman is hospitalized because of abdominal pain and persistent copious vomiting for 24
hours. Two weeks ago, she was hospitalized for treatment of atrial fibrillation; after cardioversion to a
normal sinus rhythm, she began treatment with warfarin. Yesterday, at a follow-up visit, her INR was 6
(?? normal), and her medication was discontinued. She takes no other medications. Her temperature is
37°C (98.6°F), pulse is 120/min and regular, respirations are 20/min, and blood pressure is 100/78 mm
Hg. The abdomen is distended and moderately tender; there is voluntary guarding in the epigastrium
(??? source of pain) There are no masses, organomegaly, or obvious hernias. Rectal examination shows
no abnormalities. Test of the stool for occult blood is negative. Her hemoglobin concentration has
decreased from 13 g/dL yesterday to 7.8 g/dL today. An ECG shows a normal sinus rhythm. Which of the
following is the most likely explanation for this patient's abdominal symptoms?
Intramural hematoma of the proximal small bowel
Internal small-bowel herniation
Malrotation of the small bowel
Intestinal ischemia from a cardiac embolus
Intussusception of the small bowel Correct Answer: Intramural hematoma of the proximal small bowel
A 4-year-old boy is brought to the physician by his parents because of fatigue and irritability over the
past 2 months. The family visited relatives in rural Louisiana 5 months ago where the patient ran around
barefoot. The child is active and appears normal. The conjunctivae are pale. Laboratory studies include a
normal leukocyte count with 15% eosinophils. A stool preparation discloses the parasite egg shown.
Which of the following is the most likely cause of fatigue and irritability in this patient?
Myocarditis
Circulating immune complexes
Activation of lgE
Central nervous system infestation
Microcytic anemia Correct Answer: Microcytic anemia
Two days after beginning primaquine for malaria prophylaxis, a 17-year-old African American boy is
brought to the physician because of dark urine and yellowing of his eyes. His pulse is 88/min,
respirations are 12/min, and blood pressure is 124/68 mm Hg. Examination shows scleral icterus and
pale mucous membranes. His hemoglobin concentration is 10 g/dL. A blood smear shows erythrocyte
fragments and Heinz bodies. Which of the following is the most likely explanation for these findings?
Decreased production of β-globin chains
Deficiency of glycosylphosphatidylinositol
Deficiency of glucose 6-phosphate dehydrogenase
Fragmentation of erythrocytes by fibrin strands
Decreased porphobilinogen deaminase activity Correct Answer: Deficiency of glucose 6-phosphate
dehydrogenase
,A one-day-old newborn male is found to have hemolytic disease of the newborn. Both parents are Rh-
positive, mother is positive for IgG isohemagglutinins, while father is negative. Which of the following
parental blood types most likely caused this condition?
Mother: O and Father: AB
Mother: AB and Father: O
Mother: B and Father: O
Mother: B and Father: A
Mother: O and Father: AB Correct Answer: Mother: O and Father: AB
One week after receiving 4 units of packed red blood cells for acute hemorrhage due to a gunshot
wound, a 17-year-old male develops fatigue, jaundice. Laboratory results show the
following:Hemoglobin 8.8 g/dL Hematocrit 28%, Serum total bilirubin 5 mg/dL Serum lactate
dehydrogenase 120 U/L. Liver and kidney function tests are otherwise within normal limits. Which of the
following is the most appropriate next step in diagnosis?
Ultrasonography of the gallbladder
Monospot test
Serology for hepatitis B markers
Direct and indirect antiglobulin (Coombs) tests
Cytomegalovirus antibody titer Correct Answer: Direct and indirect antiglobulin (Coombs) tests
A 6-month-old boy is brought to the physician because of left knee swelling for 24 hours. Three months
ago, he had three large hematomas on his forehead that resolved without treatment (??). His two sisters
and his mother have no history of similar symptoms. His mother's maternal uncle and her brother died
(x-linked recessive) before the age of 30 years of massive cerebral hemorrhages. Physical examination
shows deep ecchymosis over the buttocks and severe swelling of the left knee. The most likely
explanation for these findings is a deficiency of which of the following?
Factor V (proaccelerin): Factor V Leiden (FVL) results from a point mutation in the F5 gene, which
encodes the factor V protein in the coagulation cascade. FVL renders factor V (both the activated and
inactive forms) insensitive to the actions of activated protein C (aPC), a natural anticoagulant. As a
result, individuals who carry the FVL variant are at increased risk of venous thromboembolism (VTE).
However, FVL is extremely common in the population, and many individuals with the variant will never
have a VTE.
von Willebrand factor
Factor VIII (antihemophilic factor)
Factor XIII (transglutaminase)
Factor I (fibrinogen): An abnormality of fibrinogen may be suspected if there is prolongation of the
prothrombin time (PT), activated partial thromboplastin time (aPTT), and/or thrombin time (TT). In
congenital afibrinogenemia (absence of detectable fibrinogen), bleeding often occurs in the neonatal
period. Umbilical cord bleeding, which can be fatal, is the initial presentation in approximately 60 to 85
percent of cases. Other individuals with afibrinogenemia may have a later age of onset with bleeding in
the skin, gastrointestinal tract, urinary tract, or central nervous system. Joint bleeding is relatively rare.
Correct Answer: Factor VIII (antihemophilic factor)
Three days after undergoing elective laparoscopic cholecystectomy for cholelithiasis, a 42-year-old
woman has the onset of hematomas at all surgical sites. She was treated for deep venous thrombosis 3
,years ago but was not taking any medications at the time of this admission. Results of preoperative
laboratory studies were within the reference range. Prior to the operation, she received heparin and
underwent application of compression stockings. Her initial postoperative course was uncomplicated.
Heronly medication is ibuprofen. She is 163 cm (5 ft 4 in) tall and weighs 87 kg (192 lb); BMI is 33 kg/m2.
Her temperature is 37.3°C(99.2°F), pulse is 94/min, respirations are 16/min, and blood pressure is
112/74 mm Hg. Examination shows mild hematomas at all surgical sites. The abdomen is soft and
nontender. There is no organomegaly. Bowel sounds are normal. Laboratory studies show:Hemoglobin
10.3 g/dL Hematocrit 30%Leukocyte count 12,000/mm3 Platelet count 45,000/mm3 Which of the
following is the most likely cause of this patient's current findings?
Hypersplenism
Acute intermittent porphyria
Inhibition of cyclooxygenase
von Willebrand disease
Heparin-induced thrombocytopenia Correct Answer: Heparin-induced thrombocytopenia
A 3-year-old girl with Down syndrome is brought to the physician because of a 1-week history of
frequent nosebleeds, decreased appetite, and lethargy. She takes no medications. Her temperature is
38°C (100.4°F), pulse is 100/min, respirations are 20/min,and blood pressure is 80/45 mm Hg.
Examination shows no other abnormalities except for pallor. Laboratory studies show:Hemoglobin 6.5
g/dL Hematocrit 19%Leukocyte count 100,000/mm3 Segmented neutrophils 15%Atypical lymphocytes
85%Platelet count 45,000/mm3 Which of the following is the most likely mechanism of these laboratory
findings?
Bone marrow hypoplasia
Iron deficiency
Reticuloendothelial phagocytosis of platelets
Serum immunoglobulin A deficiency
Infiltration of bone marrow by leukemic blasts
Lymphocyte inhibitors of erythropoiesis Correct Answer: Infiltration of bone marrow by leukemic blasts
A 30-year-old woman, gravida 2, para 1, comes for her first prenatal visit at 26 weeks' gestation. Uterine
size is greater than expected for dates. Ultrasonography shows fetal hydrops. Which of the following is
the most appropriate next step in diagnosis?
Maternal Rh status with antibody screening
Maternal HIV antibody test
Cervical and urine cultures for group B Streptococcus
Amniocentesis for measurement of α-fetoprotein concentration
MRI of the fetus Correct Answer: Maternal Rh status with antibody screening
A 65-year-old man has had increasingly severe headaches and diffuse muscle aches during the past 3
months. He also has a 1-month history of jaw pain when chewing food and decreasing visual acuity in his
left eye. His temperature is 38°C (100.4°F). Visual acuity in his left eye is 20/100, and the left optic disc is
slightly atrophic. His muscle strength is normal. Which of the following tests should be obtained next?
CT scan of the head
Examination of cerebrospinal fluid
, Measurement of erythrocyte sedimentation rate
Electroencephalography
Antinuclear antibody assay Correct Answer: Measurement of erythrocyte sedimentation rate
A 10-year-old boy has had anemia since birth. His spleen is five times normal size. Splenectomy is
indicated if the anemia is caused by which of the following disorders?
Fanconi anemia
Hereditary spherocytosis
Glucose 6-phosphate dehydrogenase deficiency
Thalassemia major
Sickle cell disease Correct Answer: Hereditary spherocytosis
A previously healthy 72-year-old man is brought to the physician because of weakness and fatigue. His
hemoglobin concentration is 9.2 g/dl, leukocyte count is 5400/mm3, and platelet count is
350,000/mm3. A peripheral blood smear is shown. Which of the following is the most likely cause of
these findings?
Beta-Thalassemia major
Gastrointestinal blood loss
Aplastic anemia
Vitamin B12 (cobalamin) deficiency
Chronic myelogenous leukemia Correct Answer: Gastrointestinal blood loss
A 48-year-old man comes to the physician because of increasing bronzing of his skin, weakness, and
fatigue during the past 3 months. Physical examination shows bronzing of the skin, hepatomegaly, and
small testes. Serum studies show: Which of the following best explains the findings in this patient?
Ferrochelatase deficiency
Increased erythropoietin production
Ineffective erythropoiesis
Transferrin deficiency
Increased intestinal iron absorption Correct Answer: Increased intestinal iron absorption
A 3-year-old boy and his 5-year-old brother bruise easily and have recurrent hemarthrosis. Both parents
are healthy, but the mother has two younger brothers with the same symptoms and a maternal uncle
who died at 8 years of age after mild head trauma. Partial thromboplastin time is prolonged. The most
likely defect involves which of the following?
Thrombin
Factor XIII (transglutaminase)
Factor VIII (antihemophilic factor)
Factor V (proaccelerin)
von Willebrand factor Correct Answer: Factor VIII (antihemophilic factor)
An 81-year-old woman is admitted to the hospital because of a massive pulmonary embolism from a
deep venous thrombosis. Her platelet count is 160,000/mm3. Appropriate pharmacotherapy is started.
2022 Test Bank Latest
A 67-year-old woman is hospitalized because of abdominal pain and persistent copious vomiting for 24
hours. Two weeks ago, she was hospitalized for treatment of atrial fibrillation; after cardioversion to a
normal sinus rhythm, she began treatment with warfarin. Yesterday, at a follow-up visit, her INR was 6
(?? normal), and her medication was discontinued. She takes no other medications. Her temperature is
37°C (98.6°F), pulse is 120/min and regular, respirations are 20/min, and blood pressure is 100/78 mm
Hg. The abdomen is distended and moderately tender; there is voluntary guarding in the epigastrium
(??? source of pain) There are no masses, organomegaly, or obvious hernias. Rectal examination shows
no abnormalities. Test of the stool for occult blood is negative. Her hemoglobin concentration has
decreased from 13 g/dL yesterday to 7.8 g/dL today. An ECG shows a normal sinus rhythm. Which of the
following is the most likely explanation for this patient's abdominal symptoms?
Intramural hematoma of the proximal small bowel
Internal small-bowel herniation
Malrotation of the small bowel
Intestinal ischemia from a cardiac embolus
Intussusception of the small bowel Correct Answer: Intramural hematoma of the proximal small bowel
A 4-year-old boy is brought to the physician by his parents because of fatigue and irritability over the
past 2 months. The family visited relatives in rural Louisiana 5 months ago where the patient ran around
barefoot. The child is active and appears normal. The conjunctivae are pale. Laboratory studies include a
normal leukocyte count with 15% eosinophils. A stool preparation discloses the parasite egg shown.
Which of the following is the most likely cause of fatigue and irritability in this patient?
Myocarditis
Circulating immune complexes
Activation of lgE
Central nervous system infestation
Microcytic anemia Correct Answer: Microcytic anemia
Two days after beginning primaquine for malaria prophylaxis, a 17-year-old African American boy is
brought to the physician because of dark urine and yellowing of his eyes. His pulse is 88/min,
respirations are 12/min, and blood pressure is 124/68 mm Hg. Examination shows scleral icterus and
pale mucous membranes. His hemoglobin concentration is 10 g/dL. A blood smear shows erythrocyte
fragments and Heinz bodies. Which of the following is the most likely explanation for these findings?
Decreased production of β-globin chains
Deficiency of glycosylphosphatidylinositol
Deficiency of glucose 6-phosphate dehydrogenase
Fragmentation of erythrocytes by fibrin strands
Decreased porphobilinogen deaminase activity Correct Answer: Deficiency of glucose 6-phosphate
dehydrogenase
,A one-day-old newborn male is found to have hemolytic disease of the newborn. Both parents are Rh-
positive, mother is positive for IgG isohemagglutinins, while father is negative. Which of the following
parental blood types most likely caused this condition?
Mother: O and Father: AB
Mother: AB and Father: O
Mother: B and Father: O
Mother: B and Father: A
Mother: O and Father: AB Correct Answer: Mother: O and Father: AB
One week after receiving 4 units of packed red blood cells for acute hemorrhage due to a gunshot
wound, a 17-year-old male develops fatigue, jaundice. Laboratory results show the
following:Hemoglobin 8.8 g/dL Hematocrit 28%, Serum total bilirubin 5 mg/dL Serum lactate
dehydrogenase 120 U/L. Liver and kidney function tests are otherwise within normal limits. Which of the
following is the most appropriate next step in diagnosis?
Ultrasonography of the gallbladder
Monospot test
Serology for hepatitis B markers
Direct and indirect antiglobulin (Coombs) tests
Cytomegalovirus antibody titer Correct Answer: Direct and indirect antiglobulin (Coombs) tests
A 6-month-old boy is brought to the physician because of left knee swelling for 24 hours. Three months
ago, he had three large hematomas on his forehead that resolved without treatment (??). His two sisters
and his mother have no history of similar symptoms. His mother's maternal uncle and her brother died
(x-linked recessive) before the age of 30 years of massive cerebral hemorrhages. Physical examination
shows deep ecchymosis over the buttocks and severe swelling of the left knee. The most likely
explanation for these findings is a deficiency of which of the following?
Factor V (proaccelerin): Factor V Leiden (FVL) results from a point mutation in the F5 gene, which
encodes the factor V protein in the coagulation cascade. FVL renders factor V (both the activated and
inactive forms) insensitive to the actions of activated protein C (aPC), a natural anticoagulant. As a
result, individuals who carry the FVL variant are at increased risk of venous thromboembolism (VTE).
However, FVL is extremely common in the population, and many individuals with the variant will never
have a VTE.
von Willebrand factor
Factor VIII (antihemophilic factor)
Factor XIII (transglutaminase)
Factor I (fibrinogen): An abnormality of fibrinogen may be suspected if there is prolongation of the
prothrombin time (PT), activated partial thromboplastin time (aPTT), and/or thrombin time (TT). In
congenital afibrinogenemia (absence of detectable fibrinogen), bleeding often occurs in the neonatal
period. Umbilical cord bleeding, which can be fatal, is the initial presentation in approximately 60 to 85
percent of cases. Other individuals with afibrinogenemia may have a later age of onset with bleeding in
the skin, gastrointestinal tract, urinary tract, or central nervous system. Joint bleeding is relatively rare.
Correct Answer: Factor VIII (antihemophilic factor)
Three days after undergoing elective laparoscopic cholecystectomy for cholelithiasis, a 42-year-old
woman has the onset of hematomas at all surgical sites. She was treated for deep venous thrombosis 3
,years ago but was not taking any medications at the time of this admission. Results of preoperative
laboratory studies were within the reference range. Prior to the operation, she received heparin and
underwent application of compression stockings. Her initial postoperative course was uncomplicated.
Heronly medication is ibuprofen. She is 163 cm (5 ft 4 in) tall and weighs 87 kg (192 lb); BMI is 33 kg/m2.
Her temperature is 37.3°C(99.2°F), pulse is 94/min, respirations are 16/min, and blood pressure is
112/74 mm Hg. Examination shows mild hematomas at all surgical sites. The abdomen is soft and
nontender. There is no organomegaly. Bowel sounds are normal. Laboratory studies show:Hemoglobin
10.3 g/dL Hematocrit 30%Leukocyte count 12,000/mm3 Platelet count 45,000/mm3 Which of the
following is the most likely cause of this patient's current findings?
Hypersplenism
Acute intermittent porphyria
Inhibition of cyclooxygenase
von Willebrand disease
Heparin-induced thrombocytopenia Correct Answer: Heparin-induced thrombocytopenia
A 3-year-old girl with Down syndrome is brought to the physician because of a 1-week history of
frequent nosebleeds, decreased appetite, and lethargy. She takes no medications. Her temperature is
38°C (100.4°F), pulse is 100/min, respirations are 20/min,and blood pressure is 80/45 mm Hg.
Examination shows no other abnormalities except for pallor. Laboratory studies show:Hemoglobin 6.5
g/dL Hematocrit 19%Leukocyte count 100,000/mm3 Segmented neutrophils 15%Atypical lymphocytes
85%Platelet count 45,000/mm3 Which of the following is the most likely mechanism of these laboratory
findings?
Bone marrow hypoplasia
Iron deficiency
Reticuloendothelial phagocytosis of platelets
Serum immunoglobulin A deficiency
Infiltration of bone marrow by leukemic blasts
Lymphocyte inhibitors of erythropoiesis Correct Answer: Infiltration of bone marrow by leukemic blasts
A 30-year-old woman, gravida 2, para 1, comes for her first prenatal visit at 26 weeks' gestation. Uterine
size is greater than expected for dates. Ultrasonography shows fetal hydrops. Which of the following is
the most appropriate next step in diagnosis?
Maternal Rh status with antibody screening
Maternal HIV antibody test
Cervical and urine cultures for group B Streptococcus
Amniocentesis for measurement of α-fetoprotein concentration
MRI of the fetus Correct Answer: Maternal Rh status with antibody screening
A 65-year-old man has had increasingly severe headaches and diffuse muscle aches during the past 3
months. He also has a 1-month history of jaw pain when chewing food and decreasing visual acuity in his
left eye. His temperature is 38°C (100.4°F). Visual acuity in his left eye is 20/100, and the left optic disc is
slightly atrophic. His muscle strength is normal. Which of the following tests should be obtained next?
CT scan of the head
Examination of cerebrospinal fluid
, Measurement of erythrocyte sedimentation rate
Electroencephalography
Antinuclear antibody assay Correct Answer: Measurement of erythrocyte sedimentation rate
A 10-year-old boy has had anemia since birth. His spleen is five times normal size. Splenectomy is
indicated if the anemia is caused by which of the following disorders?
Fanconi anemia
Hereditary spherocytosis
Glucose 6-phosphate dehydrogenase deficiency
Thalassemia major
Sickle cell disease Correct Answer: Hereditary spherocytosis
A previously healthy 72-year-old man is brought to the physician because of weakness and fatigue. His
hemoglobin concentration is 9.2 g/dl, leukocyte count is 5400/mm3, and platelet count is
350,000/mm3. A peripheral blood smear is shown. Which of the following is the most likely cause of
these findings?
Beta-Thalassemia major
Gastrointestinal blood loss
Aplastic anemia
Vitamin B12 (cobalamin) deficiency
Chronic myelogenous leukemia Correct Answer: Gastrointestinal blood loss
A 48-year-old man comes to the physician because of increasing bronzing of his skin, weakness, and
fatigue during the past 3 months. Physical examination shows bronzing of the skin, hepatomegaly, and
small testes. Serum studies show: Which of the following best explains the findings in this patient?
Ferrochelatase deficiency
Increased erythropoietin production
Ineffective erythropoiesis
Transferrin deficiency
Increased intestinal iron absorption Correct Answer: Increased intestinal iron absorption
A 3-year-old boy and his 5-year-old brother bruise easily and have recurrent hemarthrosis. Both parents
are healthy, but the mother has two younger brothers with the same symptoms and a maternal uncle
who died at 8 years of age after mild head trauma. Partial thromboplastin time is prolonged. The most
likely defect involves which of the following?
Thrombin
Factor XIII (transglutaminase)
Factor VIII (antihemophilic factor)
Factor V (proaccelerin)
von Willebrand factor Correct Answer: Factor VIII (antihemophilic factor)
An 81-year-old woman is admitted to the hospital because of a massive pulmonary embolism from a
deep venous thrombosis. Her platelet count is 160,000/mm3. Appropriate pharmacotherapy is started.
