Anatomy NBME questions with precise |! |! |! |! |!
detailed answers |!
A homeless man has a 3-month history of decreased a-peptide, generalized wasting, low
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grade fever , worsening cough productive of blood, mucopurulent sputum. He has a 3-
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year history of alcohol abuse. Xray films of the chest show consolidation and cavitary
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lesions in the apices of the lungs. Which of the following is most likely inflammatory
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and/or immune response in the lung?
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A. Endothelial cell proliferation, vascular budding, fibroblasts
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B. Epithelioid cells, multinucleate giant cells, caseation necrosis
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C. Fibroblasts, collagen deposition, replacement of intrinsic tissue
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D. Macrophages, lymphocytes, hypergammaglobulinemia
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E. Neutrophils, vascular congestion, exudate - Correct answer ✔B. Epithelioid cells,
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multinucleate giant cells, caseation necrosis |! |! |! |!
82 year old man comes to the physician for evaluation of chest pain. He lives with his
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daughters family. He has numerous welts and abrasions and appears to be malnourished.
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He says his diet is fine. Which of the following is the most appropriate next step in
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patient care? |!
A. confront his family about the abuse
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B. enroll the family in family counseling
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C. notify social services of potential abuse
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D. place him in a nursing home
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E. refer him to a residential community - Correct answer ✔C. notify social services of
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potential abuse |!
67 year old woman has the sudden onset of dyspnea and chest pain and dies within
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minutes. Stage IV ovarian cancer was diagnosed 1 year ago, and she has been bedridden
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for 2 months. Which of the following is most likely to be found on autopsy?
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,A. Acute myocardial infarction
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B. Deep venous thrombosis
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C. Dissecting aortic aneurysm
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D. Renal papillary necrosis
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E. Rupttured berry aneurysm - Correct answer ✔B. Deep venous thrombosis
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45 year old man has a 6-month history of burning pain that begins in the epigastric area
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and ascends into the chest. Episodes occur most frequently after large meals and at night.
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Endoscopic examination shows moderately severe inflammation in the distal 3cm of the
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esophagus. Which of the following is the most likely cause of this condition?
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A. Diffuse spasm of the esophageal musculature
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B. Failure of the lower sphincter to relax after a swallow
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C. Helicobacter pylori infection
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D. Hypersection of gastric acid
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E. Inappropriate relaxation of the lower esophageal sphincter - Correct answer ✔E.
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Inappropriate relaxation of the lower esophageal sphincter |! |! |! |! |! |!
45- year old woman has an acute coronary occlusion. Within seconds, the ischemic region
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shows mitochondrial swelling and depletion of glycogen granules. Which of the following
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metabolic events is most likely cause of these cellular changes?
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A. Accumulation of free fatty acids
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B. ATP depletion
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C. Degradation of membrane phospholipid
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D. Efflux of K+
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E. Influx of Na+ - Correct answer ✔C. Degradation of membrane phospholipid
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65-year old man dies of bronchopneumonia. He has a 6-year history of progressive loss of
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
facial expression, tremors, rigidity, and slowing of voluntary movement. At autopsy, loss
|! |! |! |! |! |! |! |! |! |! |! |! |!
,of pigmented cells is noted in the substantial nigra. Which of the following additional
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abnormalities is most likely to be present? |! |! |! |! |! |!
A. Eosinophilic inclusions in neurons of the substantial nigra
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B. Loss of neurons in the caudate nuclei
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C. Microglial nodules and multinucleated giant cells in the white matter
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D. Neurofibrillary tangles in the cortical neurons
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E. Viral inclusions in the oligodendrocytes - Correct answer ✔A. Eosinophilic inclusions in
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neurons of the substantial nigra
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50 year old man has a 10-year history of poorly controlled hypertension. Vital signs are:
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Pulse 96/min |!
Respirations 16/min |!
Bp of left arm 226/120 mmHg
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Bp of right arm 218/118mmHg
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With the patient in the left lateral decubitus position, a late diastolic sound is heard best
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with the bell at the apex. Which of the following is the most likely explanation for this
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auscultatory finding? |!
A. Aortic insufficiency
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B. Aortic stenosis
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C. Mitral insufficiency
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D. Mitral stenosis
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E. Opening snap
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F. Pulmonic insufficiency
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G. Pulmonic stenosis
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H.S3
, I.S4
J. Tricuspid insufficiency - Correct answer ✔I.S4
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in gout, hyperuricemia resulting from overproduction of urate is most likely to result from
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a lack of feedback inhibition by ADP or GDP at which enzyme?
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A. Adenosine deaminase
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B. Dihydrofolate reductase
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C. Glucose 6-phosphate dehydrogenase
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D. Nucleotide phosphorylase
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E. Phosphoribosylprophosphate synthetase - Correct answer ✔E.
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Phosphoribosylprophosphate synthetase |!
a female neonate has profound hypotonia. the only known complication of pregnancy was
|! |! |! |! |! |! |! |! |! |! |! |!
polyhydramnios. The mother has a lack of facial expression and weak muscles; she says
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she did not have any problems as an infant or child. Which of the following best explains
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the difference in presentations in the mother and child?
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A. Anticipation
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B. Delayed onset
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C. Genetic heterogeneity
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D. Incomplete penetrance
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E. Pleiotropy - Correct answer ✔A. Anticipation
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An alcohol-dependent 40 year old woman who is a health-care worker has had episodic
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
symptoms of hypoglycemia for the past year. During one of these episodes, plasma
|! |! |! |! |! |! |! |! |! |! |! |! |!
glucose concentration is decreased, plasma insulin concentration is increased, and serum
|! |! |! |! |! |! |! |! |! |! |!
C-peptide concentration is not detectable. Which of the following is the most likely cause
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of the hypoglycemia?
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A. acute hepatic failure
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B. ingestion of a sulfonylurea
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detailed answers |!
A homeless man has a 3-month history of decreased a-peptide, generalized wasting, low
|! |! |! |! |! |! |! |! |! |! |! |! |!
grade fever , worsening cough productive of blood, mucopurulent sputum. He has a 3-
|! |! |! |! |! |! |! |! |! |! |! |! |!
year history of alcohol abuse. Xray films of the chest show consolidation and cavitary
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
lesions in the apices of the lungs. Which of the following is most likely inflammatory
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
and/or immune response in the lung?
|! |! |! |! |!
A. Endothelial cell proliferation, vascular budding, fibroblasts
|! |! |! |! |! |! |!
B. Epithelioid cells, multinucleate giant cells, caseation necrosis
|! |! |! |! |! |! |! |!
C. Fibroblasts, collagen deposition, replacement of intrinsic tissue
|! |! |! |! |! |! |!
D. Macrophages, lymphocytes, hypergammaglobulinemia
|! |! |! |!
E. Neutrophils, vascular congestion, exudate - Correct answer ✔B. Epithelioid cells,
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multinucleate giant cells, caseation necrosis |! |! |! |!
82 year old man comes to the physician for evaluation of chest pain. He lives with his
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
daughters family. He has numerous welts and abrasions and appears to be malnourished.
|! |! |! |! |! |! |! |! |! |! |! |! |!
He says his diet is fine. Which of the following is the most appropriate next step in
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
patient care? |!
A. confront his family about the abuse
|! |! |! |! |! |!
B. enroll the family in family counseling
|! |! |! |! |! |! |!
C. notify social services of potential abuse
|! |! |! |! |! |!
D. place him in a nursing home
|! |! |! |! |! |!
E. refer him to a residential community - Correct answer ✔C. notify social services of
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
potential abuse |!
67 year old woman has the sudden onset of dyspnea and chest pain and dies within
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
minutes. Stage IV ovarian cancer was diagnosed 1 year ago, and she has been bedridden
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
for 2 months. Which of the following is most likely to be found on autopsy?
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
,A. Acute myocardial infarction
|! |! |! |!
B. Deep venous thrombosis
|! |! |! |!
C. Dissecting aortic aneurysm
|! |! |!
D. Renal papillary necrosis
|! |! |! |!
E. Rupttured berry aneurysm - Correct answer ✔B. Deep venous thrombosis
|! |! |! |! |! |! |! |! |! |!
45 year old man has a 6-month history of burning pain that begins in the epigastric area
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
and ascends into the chest. Episodes occur most frequently after large meals and at night.
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
Endoscopic examination shows moderately severe inflammation in the distal 3cm of the
|! |! |! |! |! |! |! |! |! |! |! |! |!
esophagus. Which of the following is the most likely cause of this condition?
|! |! |! |! |! |! |! |! |! |! |! |!
A. Diffuse spasm of the esophageal musculature
|! |! |! |! |! |! |!
B. Failure of the lower sphincter to relax after a swallow
|! |! |! |! |! |! |! |! |! |!
C. Helicobacter pylori infection
|! |! |! |!
D. Hypersection of gastric acid
|! |! |! |!
E. Inappropriate relaxation of the lower esophageal sphincter - Correct answer ✔E.
|! |! |! |! |! |! |! |! |! |! |! |!
Inappropriate relaxation of the lower esophageal sphincter |! |! |! |! |! |!
45- year old woman has an acute coronary occlusion. Within seconds, the ischemic region
|! |! |! |! |! |! |! |! |! |! |! |! |!
shows mitochondrial swelling and depletion of glycogen granules. Which of the following
|! |! |! |! |! |! |! |! |! |! |! |! |!
metabolic events is most likely cause of these cellular changes?
|! |! |! |! |! |! |! |! |!
A. Accumulation of free fatty acids
|! |! |! |! |! |!
B. ATP depletion
|! |! |!
C. Degradation of membrane phospholipid
|! |! |! |! |!
D. Efflux of K+
|! |! |!
E. Influx of Na+ - Correct answer ✔C. Degradation of membrane phospholipid
|! |! |! |! |! |! |! |! |! |! |!
65-year old man dies of bronchopneumonia. He has a 6-year history of progressive loss of
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
facial expression, tremors, rigidity, and slowing of voluntary movement. At autopsy, loss
|! |! |! |! |! |! |! |! |! |! |! |! |!
,of pigmented cells is noted in the substantial nigra. Which of the following additional
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
abnormalities is most likely to be present? |! |! |! |! |! |!
A. Eosinophilic inclusions in neurons of the substantial nigra
|! |! |! |! |! |! |! |! |!
B. Loss of neurons in the caudate nuclei
|! |! |! |! |! |! |! |!
C. Microglial nodules and multinucleated giant cells in the white matter
|! |! |! |! |! |! |! |! |! |!
D. Neurofibrillary tangles in the cortical neurons
|! |! |! |! |! |! |!
E. Viral inclusions in the oligodendrocytes - Correct answer ✔A. Eosinophilic inclusions in
|! |! |! |! |! |! |! |! |! |! |! |! |!
neurons of the substantial nigra
|! |! |! |!
50 year old man has a 10-year history of poorly controlled hypertension. Vital signs are:
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
Pulse 96/min |!
Respirations 16/min |!
Bp of left arm 226/120 mmHg
|! |! |! |! |!
Bp of right arm 218/118mmHg
|! |! |! |!
With the patient in the left lateral decubitus position, a late diastolic sound is heard best
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
with the bell at the apex. Which of the following is the most likely explanation for this
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
auscultatory finding? |!
A. Aortic insufficiency
|! |! |!
B. Aortic stenosis
|! |! |!
C. Mitral insufficiency
|! |! |!
D. Mitral stenosis
|! |! |!
E. Opening snap
|! |!
F. Pulmonic insufficiency
|! |! |!
G. Pulmonic stenosis
|! |! |!
H.S3
, I.S4
J. Tricuspid insufficiency - Correct answer ✔I.S4
|! |! |! |! |! |!
in gout, hyperuricemia resulting from overproduction of urate is most likely to result from
|! |! |! |! |! |! |! |! |! |! |! |! |!
a lack of feedback inhibition by ADP or GDP at which enzyme?
|! |! |! |! |! |! |! |! |! |! |! |!
A. Adenosine deaminase
|! |! |!
B. Dihydrofolate reductase
|! |!
C. Glucose 6-phosphate dehydrogenase
|! |! |! |!
D. Nucleotide phosphorylase
|! |! |!
E. Phosphoribosylprophosphate synthetase - Correct answer ✔E.
|! |! |! |! |! |! |!
Phosphoribosylprophosphate synthetase |!
a female neonate has profound hypotonia. the only known complication of pregnancy was
|! |! |! |! |! |! |! |! |! |! |! |!
polyhydramnios. The mother has a lack of facial expression and weak muscles; she says
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
she did not have any problems as an infant or child. Which of the following best explains
|! |! |! |! |! |! |! |! |! |! |! |! |! |! |! |!
the difference in presentations in the mother and child?
|! |! |! |! |! |! |! |! |!
A. Anticipation
|! |!
B. Delayed onset
|! |!
C. Genetic heterogeneity
|! |! |!
D. Incomplete penetrance
|! |! |!
E. Pleiotropy - Correct answer ✔A. Anticipation
|! |! |! |! |! |!
An alcohol-dependent 40 year old woman who is a health-care worker has had episodic
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
symptoms of hypoglycemia for the past year. During one of these episodes, plasma
|! |! |! |! |! |! |! |! |! |! |! |! |!
glucose concentration is decreased, plasma insulin concentration is increased, and serum
|! |! |! |! |! |! |! |! |! |! |!
C-peptide concentration is not detectable. Which of the following is the most likely cause
|! |! |! |! |! |! |! |! |! |! |! |! |! |!
of the hypoglycemia?
|! |!
A. acute hepatic failure
|! |! |! |!
B. ingestion of a sulfonylurea
|! |! |! |! |!
