NBME CBSE REAL EXAM 200 QUESTIONS AND
ANSWERS LATEST 2023-2024 (usmle step 1)MEDICAL
EXAMINATION LATEST UPDATES JUNE 2023 A
19yo M in MVC. Penetrating wound to right cerebral cortex with paralysis of the left lower extremity,
fracture of right mid humerus with severing of the radial nerve, and a fracture of right tibia. After 10
weeks, DTR strongest in which locations? - ANSWER- Left Achilles tendon
40yo F with 1-year hx of episodes of crampy abdominal pain, intermittent diarrhea, and rectal bleeding
with passage of mucus. BMI 18. Abdominal exam: diffuse tenderness with no rebound.
Sigmoidoscopy shows diffuse ulcers. Initial Rx? - ANSWER- Sulfasalazine
27yo M for employment exam. No Hx of major illness. Never been sexually active. Minimal contact with
parents and siblings, no hobbies.
Doesn't feel depressed. Shrugs in response to congratulations about his
new job. Flat affect. Personality disorder? - ANSWER- Schizoid
30yo F has ptosis, ophthalmoplegia, and diplopia. Serum shows autoantibody with affinity for
acetylcholine receptor at the postsynaptic neuromuscular junction. Which neoplasm? - ANSWER-
Thymoma
Exam scaled so scores are normally distributed with mean of 500 and
SD of 100. Which % are between 400 and 600? - ANSWER- 67%
62yo M with pericardial friction rub 3 days after acute myocardial
infarction. Cause of rub? - ANSWER- Fibrinous pericarditis
42yo F with 1-mo Hx of abdominal pain, after eating fatty meals. BMI
31. PE shows jaundice and tenderness of RUQ. Increase of which liver GRADE.
function? - ANSWER- Cholesterol synthesis
, NBME CBSE REAL EXAM 200 QUESTIONS AND
ANSWERS LATEST 2023-2024 (usmle step 1)MEDICAL
EXAMINATION LATEST UPDATES JUNE 2023 A
70yo M with recent loss of mental function. Hx of weight loss. No drugs. VSS, not dehydrates. Mild
anemia. Labs show Na 110, Cl 85, K 4.4, BUN 15, Cr 15; Plasma osmolality 250; Urine osmolality 750. Dx? -
ANSWER- Pulmonary neoplasm
38yo F with 2-year hx of pain and heavy flow with menses causes her to miss work. Ibuprofen not
effective. One 6yo daughter; unable to conceive another child. PE shows mildly enlarged left ovary and
retroflexed uterus. U/S shows substantial evidence of ovarian cysts and one peritoneal cyst. Bx of cyst
will show? - ANSWER- Proliferative
endometrial tissue
40yo M skin extremely sensitive to sunlight, which causes formation of vessicles and blisters on the skin
which take weeks to heal. Diagnosed with disorder caused by increased synthesis of compounds in the
skin that are subject to excitation by visible light. Which biochemical pathway is defective? - ANSWER-
Heme synthesis
60yo M with 6-month hx of fatigue. Four years ago, had subtotal gastrectomy after gunshot wound.
Drinks 6-8 beers daily. PE shows paresthesias of both hands. Labs show: Hb 8, HCT 24%, MCV 115,
WBC 5k, Platelets 165k, RBC Folic acid 500 (N = 125-600) B12 10 (N = 160-195). Cause is absence of? -
ANSWER- Parietal cells
RCT to compare wound healing and cosmetic differences between two surgical procedures for closing skin
after C section. Surgical specialists cannot be blinded to the procedure. Results show procedure A has a
lower rate of wound infection compared with B (relative risk 0.66, 95% CI 0.3 - 1.45). Which accurately
represents comparison between A and B? - ANSWER- Neither procedure is superior?
GRADE.
40yo M with interstitial pulmonary fibrosis has greater maximal expiratory flow rate than predicted.
Which best explains this? - ANSWER- Increased radial traction on airways
, NBME CBSE REAL EXAM 200 QUESTIONS AND
ANSWERS LATEST 2023-2024 (usmle step 1)MEDICAL
EXAMINATION LATEST UPDATES JUNE 2023 A
NBME CBSE REAL EXAM 200 QUESTIONS AND
ANSWERS LATEST 2023-2024 (usmle step 1)MEDICAL
EXAMINATION LATEST UPDATES JUNE 2023 A GRADE.
70yo M dies in a motor vehicle collision. Was undergoing evaluation for
occult blood in the stool. Photo of transverse colon shown. Dx? - ANSWER- Tubular adenoma
38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical shows inflamed nasal mucosa. No
congestion in lower lung. Pharmacotherapy? - ANSWER- Loratadine
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P 88/min, BP 102-70. PE shows
pale conjunctivae. CXR shows bilateral interstitial infiltrates. Blood spontaenously agglutinates while
awaiting transport to the laboratory. Antibody isotypes causing
agglutination? - ANSWER- IgM
24yo M with small tender blisters on his penis 3 days after unprotected
sex. Photograph shown. Causal agent? - ANSWER- HSV-2
42yo F with 3-year hx of an intermittent facial rash, including the forehead, eyelids, nose, and cheeks. Rash
seems to be getting worse since she moved from New York to Florida last year. Spicy foods precipitate a
flushing reaction that seems to exacerbate the rash. PE shows erythema over the nose and cheeks, with
scattered telangiectasias and a few papules. Dx? - ANSWER- Rosacea
53yo M returned from Africa, has fever, headache, and abdominal discomfort. Received appropriate
vaccinations prior to the trip. T 39.4C.
A wright-stained peripheral smear shown. Dx? - ANSWER- Malaria
, NBME CBSE REAL EXAM 200 QUESTIONS AND
ANSWERS LATEST 2023-2024 (usmle step 1)MEDICAL
68yo F with T2DM and hypertension
EXAMINATION that has been poorly
LATEST controlled
UPDATES despite
JUNE 2023hydrochlorothiazide
A
treatment. BP 150/96, Labs show serum
Rx,
glucose concentration of 130 and proteinuria. In addition to current
which is most appropriate pharmacotherapy? - ANSWER- Lisinopril
35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse, watery diarrhea for 8 hours
despite a lack of oral intake. Recently returned from a medical relief trip to a remove village in
Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin and decreased capillary refill. Stool for
occult blood is negative; stool is gray and turbid. Gram stain shows gram-negative, comma-shaped
bacteria; no erythrocytes of leukocytes. MOA of toxin? - ANSWER- Activation
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving chemotherapy with
fluorouracil, leucovorin, and Irinotecan. prescribed opioid antidiarrheal agent with no CNS effects. Which
med? - ANSWER- Loperamide
of adenylyl cyclase
59yo F with gradual onset of lack of muscle control in her left arm and leg. Sx 1 mo ago after dx with
metastatic breast cancer. PE shows ataxia
of left upper and lower extremities. Muscle strength, DTR, sensation, proprioception normal. Metastatic
tumor in which location? - ANSWER- cerebellum
GRADE.
ANSWERS LATEST 2023-2024 (usmle step 1)MEDICAL
EXAMINATION LATEST UPDATES JUNE 2023 A
19yo M in MVC. Penetrating wound to right cerebral cortex with paralysis of the left lower extremity,
fracture of right mid humerus with severing of the radial nerve, and a fracture of right tibia. After 10
weeks, DTR strongest in which locations? - ANSWER- Left Achilles tendon
40yo F with 1-year hx of episodes of crampy abdominal pain, intermittent diarrhea, and rectal bleeding
with passage of mucus. BMI 18. Abdominal exam: diffuse tenderness with no rebound.
Sigmoidoscopy shows diffuse ulcers. Initial Rx? - ANSWER- Sulfasalazine
27yo M for employment exam. No Hx of major illness. Never been sexually active. Minimal contact with
parents and siblings, no hobbies.
Doesn't feel depressed. Shrugs in response to congratulations about his
new job. Flat affect. Personality disorder? - ANSWER- Schizoid
30yo F has ptosis, ophthalmoplegia, and diplopia. Serum shows autoantibody with affinity for
acetylcholine receptor at the postsynaptic neuromuscular junction. Which neoplasm? - ANSWER-
Thymoma
Exam scaled so scores are normally distributed with mean of 500 and
SD of 100. Which % are between 400 and 600? - ANSWER- 67%
62yo M with pericardial friction rub 3 days after acute myocardial
infarction. Cause of rub? - ANSWER- Fibrinous pericarditis
42yo F with 1-mo Hx of abdominal pain, after eating fatty meals. BMI
31. PE shows jaundice and tenderness of RUQ. Increase of which liver GRADE.
function? - ANSWER- Cholesterol synthesis
, NBME CBSE REAL EXAM 200 QUESTIONS AND
ANSWERS LATEST 2023-2024 (usmle step 1)MEDICAL
EXAMINATION LATEST UPDATES JUNE 2023 A
70yo M with recent loss of mental function. Hx of weight loss. No drugs. VSS, not dehydrates. Mild
anemia. Labs show Na 110, Cl 85, K 4.4, BUN 15, Cr 15; Plasma osmolality 250; Urine osmolality 750. Dx? -
ANSWER- Pulmonary neoplasm
38yo F with 2-year hx of pain and heavy flow with menses causes her to miss work. Ibuprofen not
effective. One 6yo daughter; unable to conceive another child. PE shows mildly enlarged left ovary and
retroflexed uterus. U/S shows substantial evidence of ovarian cysts and one peritoneal cyst. Bx of cyst
will show? - ANSWER- Proliferative
endometrial tissue
40yo M skin extremely sensitive to sunlight, which causes formation of vessicles and blisters on the skin
which take weeks to heal. Diagnosed with disorder caused by increased synthesis of compounds in the
skin that are subject to excitation by visible light. Which biochemical pathway is defective? - ANSWER-
Heme synthesis
60yo M with 6-month hx of fatigue. Four years ago, had subtotal gastrectomy after gunshot wound.
Drinks 6-8 beers daily. PE shows paresthesias of both hands. Labs show: Hb 8, HCT 24%, MCV 115,
WBC 5k, Platelets 165k, RBC Folic acid 500 (N = 125-600) B12 10 (N = 160-195). Cause is absence of? -
ANSWER- Parietal cells
RCT to compare wound healing and cosmetic differences between two surgical procedures for closing skin
after C section. Surgical specialists cannot be blinded to the procedure. Results show procedure A has a
lower rate of wound infection compared with B (relative risk 0.66, 95% CI 0.3 - 1.45). Which accurately
represents comparison between A and B? - ANSWER- Neither procedure is superior?
GRADE.
40yo M with interstitial pulmonary fibrosis has greater maximal expiratory flow rate than predicted.
Which best explains this? - ANSWER- Increased radial traction on airways
, NBME CBSE REAL EXAM 200 QUESTIONS AND
ANSWERS LATEST 2023-2024 (usmle step 1)MEDICAL
EXAMINATION LATEST UPDATES JUNE 2023 A
NBME CBSE REAL EXAM 200 QUESTIONS AND
ANSWERS LATEST 2023-2024 (usmle step 1)MEDICAL
EXAMINATION LATEST UPDATES JUNE 2023 A GRADE.
70yo M dies in a motor vehicle collision. Was undergoing evaluation for
occult blood in the stool. Photo of transverse colon shown. Dx? - ANSWER- Tubular adenoma
38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical shows inflamed nasal mucosa. No
congestion in lower lung. Pharmacotherapy? - ANSWER- Loratadine
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P 88/min, BP 102-70. PE shows
pale conjunctivae. CXR shows bilateral interstitial infiltrates. Blood spontaenously agglutinates while
awaiting transport to the laboratory. Antibody isotypes causing
agglutination? - ANSWER- IgM
24yo M with small tender blisters on his penis 3 days after unprotected
sex. Photograph shown. Causal agent? - ANSWER- HSV-2
42yo F with 3-year hx of an intermittent facial rash, including the forehead, eyelids, nose, and cheeks. Rash
seems to be getting worse since she moved from New York to Florida last year. Spicy foods precipitate a
flushing reaction that seems to exacerbate the rash. PE shows erythema over the nose and cheeks, with
scattered telangiectasias and a few papules. Dx? - ANSWER- Rosacea
53yo M returned from Africa, has fever, headache, and abdominal discomfort. Received appropriate
vaccinations prior to the trip. T 39.4C.
A wright-stained peripheral smear shown. Dx? - ANSWER- Malaria
, NBME CBSE REAL EXAM 200 QUESTIONS AND
ANSWERS LATEST 2023-2024 (usmle step 1)MEDICAL
68yo F with T2DM and hypertension
EXAMINATION that has been poorly
LATEST controlled
UPDATES despite
JUNE 2023hydrochlorothiazide
A
treatment. BP 150/96, Labs show serum
Rx,
glucose concentration of 130 and proteinuria. In addition to current
which is most appropriate pharmacotherapy? - ANSWER- Lisinopril
35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse, watery diarrhea for 8 hours
despite a lack of oral intake. Recently returned from a medical relief trip to a remove village in
Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin and decreased capillary refill. Stool for
occult blood is negative; stool is gray and turbid. Gram stain shows gram-negative, comma-shaped
bacteria; no erythrocytes of leukocytes. MOA of toxin? - ANSWER- Activation
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving chemotherapy with
fluorouracil, leucovorin, and Irinotecan. prescribed opioid antidiarrheal agent with no CNS effects. Which
med? - ANSWER- Loperamide
of adenylyl cyclase
59yo F with gradual onset of lack of muscle control in her left arm and leg. Sx 1 mo ago after dx with
metastatic breast cancer. PE shows ataxia
of left upper and lower extremities. Muscle strength, DTR, sensation, proprioception normal. Metastatic
tumor in which location? - ANSWER- cerebellum
GRADE.
