NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST)

NBME CBSE - QUESTIONS AND ANSWERS (ACTUAL TEST) 62 year old woman - osteoporosis - a bisphosphonate is prescribed. The expected beneficial effect of the drug is due to which of the following? Correct Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct Ans - 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? Correct Ans - Infectious Mononucleosis 57 year old man - radiation therapy for squamous cell carcinoma of the lung. Despite therapy, tumor increases in size and he dies 6 months later. The progressive tumor growth is due to a defect in cell cycle arrest in which of the following phases of cell cycle? Correct Ans - G1 28 year old - lived in sub-Saharan Africa - until he came to the US. Temp of 100.4 - imaging shows bilateral hydroureter and hydronephrosis. Biopsy shows marked fibrosis and scattered granulomas. DX? Correct Ans - Schistosomiasis A couple with a family history of a-thalassemia. Woman has one gene deletion and man has two gene deletion. If the two gene is trans - what percentage of offspring will have a two gene deletion? Correct Ans - 50% previously healthy 40 year brought to emergency department by her husband - 2 day history of fever, lethargy, confusion. PE shows scattered petechiae and ecchymoses over the lower extremities - 3+ polychromasia and 3+ schistocytes and Low platelets Dx? Correct Ans - Thrombotic Thrombocytopenia Purpura 16 year old boy - is admitted to the ER because of a knife wound to the left side of his chest. An X-ray of the chest shows an air-fluid level in the left side of the chest, partial collapse of the left lung, and the elevation of the stomach bubble. The mediastinum is midline. DX? Correct Ans - Hemopneumpothorax under tension 49 year old woman - coronary artery disease - BP 140/90 - High Cholesterol, High LDL (190), High triglycerides (350) - TX with atorvastatin and losartan. What are the effects on HDL and Triglycerides? Correct Ans - HDL increased Triglycerides Decreased 73 yeare old - diffuse weakness and tingling of her arms and legs. Sensation and vibration and position is decreased in all extremities. What vitamin deficiency? Correct Ans - Vitamin B12 - (cyanocobalamin) Tea and Toast - low B12 in diet 15 year old girl - 3 month history of acne - which is the underlying cause of the patients acne? Correct Ans - Stimulation of Sebaceous Glands by androgens b. ACNE = Propionibacterium ACNE 4 year old from Brazil - PE shows single 12x10cm lesion in the right side of jaw with diffuse regular edges. Photomicrographs of an incisional biopsy (looks like Burkitts Lymphoma/ Starry night) - which of the processes most likely to occur in the region indicated by the arrow? Correct Ans - Apoptosis b. Endemic Burkitt lymphoma can happen in Brazil as well as Africa (jaw lesion, puffy face). 51 year old - lump on tongue - 1 pack smoking history for 30 years. 1.5 cm mass on apex of tongue. It is most appropriate to evaluate which lymph nodes first for evidence of metastasis? Correct Ans - Submental 15 year old boy - ER - 2 hour history of confusio