NBME - NEW TESTS
62 year old woman - osteoporosis – a bisphosphonate is prescribed. The expected
beneficial effect of the drug is due to which of the following?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
, 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?
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?
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?
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?
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?
Submental
62 year old woman - osteoporosis – a bisphosphonate is prescribed. The expected
beneficial effect of the drug is due to which of the following?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
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?
, 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?
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?
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?
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?
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?
Submental
