NBME CBSE ACTUAL TEST QUESTIONS AND ANSWERS (Quiz bank with All the Correct Answers) (USMLE STEP 1) Medication Examination

12 year old boy- persistent rash around his nose and mouth for 4 months. Decreased appetite and unintentional weight loss. Rash began after he started a new school. Grades are falling. Rash mild redness and flaking. PE shows conjunctival injection, eczematous eruption on the nasolabial folds, friable with gold stippling. Cause of condition? - inhalant abuse Intellectual decline A 25-year-old woman - overdose of barbiturates and is found unresponsive several hours later by her husband. PT is comatose and undergoes endotracheal intubation. 3 weeks later she has no purposeful response to stimuli. The patient signed a living will - consistent with its directives that mechanical ventilation be discontinued. Appropriate next step? - extubate the patient and discontinue mechanical ventilation, make no attempt at resuscitation A 63-year-old woman - repair of leaking berry aneurysm in the circle of Willis. Two days later, a CT scan of the head shows widening of the subarachnoid space. What change in CSF causes the finding? - Decreased movement through arachnoid villi arachnoid villi drains the CSF from the subarachnoid space to the venous system; if this part becomes defective then you can imagine all that CSF now building up in the subarachnoid space. acute SAH can lead to decreased absorption and movement via arachnoid villi Choroid plexus - make Arachnoid - Absorbs A 68 y/o - 9 month history of abdominal pain after meals. 24lb weight loss. She avoids eating because of cramping pain that lasts 1 hour after meals. PE shows thin body frame and a soft nontender abdomen. BP 160/90 A CT scan shows a 3-cm ectatic (dialated) aorta. Which pairs of arteries is most likely involved in this patient? - inferior mesenteric and superior mesenteric Mesenteric cause post prandial pain - AAA compression of duodenum at 3rd Chronic Mesenteric Ischemia aka intestinal angina. abdominal aortic aneurysm. Generally, they tend to occur below the renal branches so I went with the two closest branches- SMA In a study of antibiotic resistance, strain of Escherichia Coli to ampicillin but sensitive to streptomycin is cultured with a strain of Salmonella Enteritidis sensitive to ampicillin but resistant to streptomycin. After 4 hours of cocultivation, Salmonella Enteritidis are resistant to both antibiotics. Mechanism of ampicillin resistance by the Salmonella Enteritidis? - only cookie are independently associated with E Coli OR 1 indicates increased occurrence of event. 38 year old woman gravida 4m, para 4 - 6 month history of urinary incontinence when sneezing and coughing - Leakage occurs when patient performs valsalva - Instructed to do kegel exercises - which unaffected by kegel exercise to strengthen muscles of perineum. Which muscle are unaffected by the exercise? - Internal Anal Sphincter Internal anal sphincter = parasympathetic/sympathetic control external anal sphincter = skeletal muscle and controlled by pudendal nerve 26-year-old man - 40 minutes after MVC - BP is 90/60. Systolic blood pressure 20 mm Hg with inspiration. PE shows JVD. There is distant heart sounds. DX? - Pericardial Tamponade Hypotension Distant Heart Sounds, Distended Jugular Vein, Electrical Alternans pulsus paradoxus, a sign in which blood pressure decreases drastically during inspiration. Pulsus paradoxus is a classic sign of pericardial tamponade 23-year-old woman - SOBs for 2 weeks, PE Shows no abnormalities - Na+ 135, HCO3 15, Cl 110- Most likely diagnosis? - Renal Tubular Acidosis normal anion gap (10) Na- Cl - HCO3= 10 High Anion Gap needs to be greater than 12 HARDASS A 30-year-old woman - chronic renal failure and normocytic anemia - Following recombinant EPO, her hemoglobin concentration increases due to increased activity of 5- aminolevulinic acid synthase in erythrocytes. This enzyme regulates the reaction involving the condensation of which compounds? - Glycine and Succinyl CoA substrates used the first step in heme synthesis 38 year old woman gravida 4m, para 4 - 6 month history of urinary incontinence when sneezing and coughing - Leakage occurs when patient performs valsalva - Instructed to do kegel exercises - which unaffected by kegel exercise to strengthen muscles of perineum. Which muscle are unaffected by the exercise? - Internal Anal Sphincter Not under voluntary control 26-year-old man - 40 minutes after MVC - BP is 90/60. Systolic blood pressure 20 mm Hg with inspiration. PE shows JVD. There is distant heart sounds. DX? - Pericardial Tamponade Hypotension Distant Heart Sounds, Distended Jugular Vein