NBME subject tests wrong answers
Two days after undergoing a right hip replacement operation, a 67-years-old woman has
shortness of breath and pain on the side of her back with deep breathing. She appears anxious.
Her pulse is 100/min, and respirations are 24/min. A pleureal friction rub is heard in the right
lung base. Examination of the right calf shows erythema and induration. Immediate treatment
with oxygen, 4L/min via nasal cannula, is initiadet. Arterial blood gas analysis shows:
ph: 7.54
pCO2: 29 mmHg
pO2: 61 mmHg
CT angiography of the chest shows a large embolism occluding blood flow to the right lower
lobe. Which of the following best describes the current ventilation-perfusion relationship in the
right lobe of this patient?
A) Dead space
B) Diffusion abnormality
C) Hypoventilation
,D) Low FiO2
E) Shunt A) Dead space
16-year-old girl 20 minutes after generalized tonic-clinic seizure at home. Two more seizures
after arrival. Unable to urinate, confused. P 120/min rr 24min, BP 170/109. Enlarged uterus.
Ultrasonography shows normal fetus consistent in size with 30-week gestation. Diagnosis?
Eclampsia
55-year-old man comes to the physician because of a 3-day history of fever, chills, nausea,
vomiting, and diarrhea. He says he has been unable to eat or drink anything without vomiting
and has had little urine production during the past 12 hours. His temperature is 37.8°C (100°F).
His pulse is 92/min, and blood pressure is 110/70 mm Hg while supine; pulse is 110/min, and
blood pressure is 80/60 mm Hg while standing. Physical examination shows dry mucous
membranes and a soft abdomen with mild, diffuse tenderness. Laboratory studies :
Leukocyte count 7200/mm3
Serum:
Na+ 146 mEq/L
Urea nitrogen 50 mg/dL
Creatinine 2.2 mg/dL
,Uric acid 10.2 mg/dL
Urine:
Specific gravity 1.030
RBC 0/hpf
Protein negative
Na+ 10 mEq/L
Creatinine 19 mg/dL
Which of the following is the most likely cause of the laboratory findings in this patient?
A.Acute tubular necrosis
B.Bladder outlet obstruction
C.Interstitial nephritis
D.Membranous gl E.Volume depletion
9-mo old brought to ED bcof severe respiratory distress for 1 hr. respirations 80/min. 3rd
percentile for lenght and weight. Physical exam: shows cyanosis. Despite appropriate measures,
the pt dies. Autopsy findings show a ventricular septal defect and persistent truncus arteriosus.
, Which of the following populations of cells was most likely absent during early fetal cardiac
development in this patient?
A) Ectodermal neural crest
B) Extraembryonic mesoderm
C) Mantle layer neuroblasts
D) Mesothelial cells
E) Spalnchnopleuric mesoderm A) Ectodermal neural crest
70-yoF found to have persistent fever despite IV broad-spectrum ABX therapy 3 days after
undergoing operative excision of the anterior pelvic organs for recurrent cervical carcinoma.
Temp: 38.5°C (101.3°F). Physical exam:presence of a central venous catheter that was placed on
the day of the operation. There is also a well-healing abdominal wound without erythema and
with two drains in place. Blood cultures and cultures of the tip of the central catheter on a
sheep blood agar plate grow the organism shown in the photograph. A Gram stain of one of the
colonies shows 4-μm, elliptical, purple, budding organisms. Which of the following is the most
likely causal organism?
A-Candida albicans
Two days after undergoing a right hip replacement operation, a 67-years-old woman has
shortness of breath and pain on the side of her back with deep breathing. She appears anxious.
Her pulse is 100/min, and respirations are 24/min. A pleureal friction rub is heard in the right
lung base. Examination of the right calf shows erythema and induration. Immediate treatment
with oxygen, 4L/min via nasal cannula, is initiadet. Arterial blood gas analysis shows:
ph: 7.54
pCO2: 29 mmHg
pO2: 61 mmHg
CT angiography of the chest shows a large embolism occluding blood flow to the right lower
lobe. Which of the following best describes the current ventilation-perfusion relationship in the
right lobe of this patient?
A) Dead space
B) Diffusion abnormality
C) Hypoventilation
,D) Low FiO2
E) Shunt A) Dead space
16-year-old girl 20 minutes after generalized tonic-clinic seizure at home. Two more seizures
after arrival. Unable to urinate, confused. P 120/min rr 24min, BP 170/109. Enlarged uterus.
Ultrasonography shows normal fetus consistent in size with 30-week gestation. Diagnosis?
Eclampsia
55-year-old man comes to the physician because of a 3-day history of fever, chills, nausea,
vomiting, and diarrhea. He says he has been unable to eat or drink anything without vomiting
and has had little urine production during the past 12 hours. His temperature is 37.8°C (100°F).
His pulse is 92/min, and blood pressure is 110/70 mm Hg while supine; pulse is 110/min, and
blood pressure is 80/60 mm Hg while standing. Physical examination shows dry mucous
membranes and a soft abdomen with mild, diffuse tenderness. Laboratory studies :
Leukocyte count 7200/mm3
Serum:
Na+ 146 mEq/L
Urea nitrogen 50 mg/dL
Creatinine 2.2 mg/dL
,Uric acid 10.2 mg/dL
Urine:
Specific gravity 1.030
RBC 0/hpf
Protein negative
Na+ 10 mEq/L
Creatinine 19 mg/dL
Which of the following is the most likely cause of the laboratory findings in this patient?
A.Acute tubular necrosis
B.Bladder outlet obstruction
C.Interstitial nephritis
D.Membranous gl E.Volume depletion
9-mo old brought to ED bcof severe respiratory distress for 1 hr. respirations 80/min. 3rd
percentile for lenght and weight. Physical exam: shows cyanosis. Despite appropriate measures,
the pt dies. Autopsy findings show a ventricular septal defect and persistent truncus arteriosus.
, Which of the following populations of cells was most likely absent during early fetal cardiac
development in this patient?
A) Ectodermal neural crest
B) Extraembryonic mesoderm
C) Mantle layer neuroblasts
D) Mesothelial cells
E) Spalnchnopleuric mesoderm A) Ectodermal neural crest
70-yoF found to have persistent fever despite IV broad-spectrum ABX therapy 3 days after
undergoing operative excision of the anterior pelvic organs for recurrent cervical carcinoma.
Temp: 38.5°C (101.3°F). Physical exam:presence of a central venous catheter that was placed on
the day of the operation. There is also a well-healing abdominal wound without erythema and
with two drains in place. Blood cultures and cultures of the tip of the central catheter on a
sheep blood agar plate grow the organism shown in the photograph. A Gram stain of one of the
colonies shows 4-μm, elliptical, purple, budding organisms. Which of the following is the most
likely causal organism?
A-Candida albicans
