NBME CBSE (usmle step 1)MEDICAL
EXAMINATION Questions And Answers Verified
100% Correct
20yo man with 6-hour difficulty breathing and vomiting. 10-year history
of type 1 diabetes on insulin. Pulse 90, respirations 30 and deep, bp
90/60. Physical shows dehydration. Labs: Na+ 130, K+ 6.5, HCO3 5,
glucose 500, pH 7.2, pCO2 25 mm Hg. Which compound stimulated
hormone-sensitive lipase in adipocytes causing accumulation of
metabolites causing acidosis? - ANSWER- epinephrine
Physician sad to inform patient of progression of carcinoma to the
terminal phase. Physician's face makes patient cry and ask, "It's bad
news, isn't it?" Which is best response? - ANSWER- "Yes, it is."
75yo man 2-year history of decreased force of urinary stream, urinate
several times throughout night. BUN 55, Cr 5.0. Ultrasound shows
bilateral hydronephrosis and dilated ureter. Mechanism of renal failure?
- ANSWER- Increased hydrostatic pressure in Bowman space
4yo boy two bacterial urinary tract infections past year. Physical exam
normal. Radiologic studies show dilation of left ureter and renal pelvis,
minimal left-sided renal function. Left nephrectomy done. Photo: dilated
renal pelvis and ureter. Which is cause of renal disease? - ANSWER-
congenital urethral obstruction
45yo man poorly controlled type 2 diabetes 1-month low-grade fever.
Getting hemodialysis for end-stage renal disease. T 37 C (98.6 F), pulse
72, bp 144/92. Physical subclavian catheter below right clavicle. Lungs
clear. Cardiac exam no murmurs. Blood cultures grow nonhemolytic,
,catalase-negative, gram-positive cocci in pairs and chains. Which
organism? - ANSWER- Enterococcus faecalis
3yo boy sickle cell disease with fever and pain over left foot 3 weeks.
Hematocrit stable. Leukocyte count 15,000 predominance of
neutrophils. Which is most likely explanation for findings? - ANSWER-
osteomyelitis
10yo girl well-child examination. No menstrual period. 50th percentile
height and weight. Physical exam absence of breast bud development
and no pubic or axillary hair. It is most appropriate to tell mother that
first objective sign of puberty will be which? - ANSWER- Breast bud
development
45yo woman follow-up exam after 8 weeks tamoxifen therapy for
estrogen and progesterone positive invasive ductal carcinoma of breast.
50yo sister also hormone-sensitive breast cancer. Physical exam normal.
Serum decreased concentrations of endoxifen, active metabolite of
prodrug tamoxifen. Genetic analysis shows homozygous cytochrome
P450 2D6*4 alleles. Likelihood patient's sisters has same alleles? -
ANSWER- 25%
60yo man progressive shortness of breath past 3 months. Worked in
shipyard. Respirations 25. Bilateral basilar crepitant crackles. Xray chest
reticulonodular pulmonary infiltrates consistent with interstitial fibrosis.
Picture: sputum sample of elongate structures (ferruginous body).
Fibrosis initiated by interaction of structures with which cell? -
ANSWER- Alveolar macrophages
,30yo woman 20 weeks gestation, uncomplicated pregnancy. Fundal
height is greater than expected for gestational age. Ultrasound shows
increased amniotic fluid. Which abnormality is cause? - ANSWER-
Tracheoesophageal atresia
43yo woman for health maintenance exam. Physician 30 minutes late for
appointment because of emergency, when enters, patients checks watch.
Which is best initial response? - ANSWER- "I'm sorry I got delayed. I
hope I haven't made you late somewhere else."
27yo woman 12-hour history of fever and abdominal pain. History of
recurrent urinary tract infections. Temperature is 39 C (102.2 F).
Physical exam tenderness of right flank. Abdominal xrays bilateral
staghorn renal calculi. Urinalysis pH 8, many RBCs, WBC, bacteria.
Calculi composed of? - ANSWER- struvite
48yo nulligravid woman with excessive uterine bleeding for 3 months.
Bleeding during menses and at irregular intervals. Menses were regular
before. BMI 27. Pelvic exam: adnexae are nonpalpable. Endometrial
curettage shows abundant tissue. Which is cause of symptoms? -
ANSWER- Endometrial hyperplasia
65yo woman surgical repair of aneurysm right internal carotid artery in
cavernous sinus. Three days later on physical exam, right pupil larger
than left pupil. Weakness of eye movement. Diagram of coronal section
through middle cranial fossa shown. Which nerve is damaged? -
ANSWER- A (CN III)
55yo woman 6-week history low energy, irritability, crying spells,
difficulty falling asleep, wakes up during night, cannot focus. Taking
lorazepam for 15y for generalized anxiety disorder. Taking estrogen
, replacement therapy for postmenopausal symptoms. Vital signs normal.
Physical exam normal. Mental status shows constricted affect. Mood is
"testy." Speech is slowed. No psychosis. Wishes she wouldn't wake up
but doesn't plan to harm herself. Cause of symptoms? - ANSWER-
Major depressive disorder
10yrs after total gastrectomy, 60yo man difficulty walking. Diffuse
spasticity in arms and legs, impaired proprioception in his feet, increased
muscle stretch reflexes in arms and knees, absence of muscle stretch
reflexes in ankles, bilateral extensor plantar responses. Which vitamin is
deficient? - ANSWER- B12 (cobalamin)
80yo man type 2 diabetes 2-month history severe constipation. Laxatives
haven't relieved symptoms. Abdominal exam shows distention.
Colonoscopy shows no abnormalities. Patient has dysfunction of which
nerve? - ANSWER- Pelvic splanchnic
34yo man lightheaded after running 12 miles of marathon hot day. Pulse
130 bp 80/60. Which changes to autonomic nervous system occurred? -
ANSWER- B. Sympathetic efferent activity increased, parasympathetic
efferent activity decreased
6-Mercaptopurine (6-MP) used to treat acute lymphoblastic leukemia
(ALL). 6-MP acted on by enzymes to make 6-thioguanine nucleotides
(6-TGN). Efficacy and toxicity of 6-MP correlated with 6-TGN. 6-MP
acted on by xanthine oxidase (XO), thiopurine methyltransferase
(TPMT), leading to inactive metabolites. Which are clinical
consequences of ALL patients homozygous for low-activity alleles of
TPMT? - ANSWER- They may be given normal doses of 6-MP (?)
EXAMINATION Questions And Answers Verified
100% Correct
20yo man with 6-hour difficulty breathing and vomiting. 10-year history
of type 1 diabetes on insulin. Pulse 90, respirations 30 and deep, bp
90/60. Physical shows dehydration. Labs: Na+ 130, K+ 6.5, HCO3 5,
glucose 500, pH 7.2, pCO2 25 mm Hg. Which compound stimulated
hormone-sensitive lipase in adipocytes causing accumulation of
metabolites causing acidosis? - ANSWER- epinephrine
Physician sad to inform patient of progression of carcinoma to the
terminal phase. Physician's face makes patient cry and ask, "It's bad
news, isn't it?" Which is best response? - ANSWER- "Yes, it is."
75yo man 2-year history of decreased force of urinary stream, urinate
several times throughout night. BUN 55, Cr 5.0. Ultrasound shows
bilateral hydronephrosis and dilated ureter. Mechanism of renal failure?
- ANSWER- Increased hydrostatic pressure in Bowman space
4yo boy two bacterial urinary tract infections past year. Physical exam
normal. Radiologic studies show dilation of left ureter and renal pelvis,
minimal left-sided renal function. Left nephrectomy done. Photo: dilated
renal pelvis and ureter. Which is cause of renal disease? - ANSWER-
congenital urethral obstruction
45yo man poorly controlled type 2 diabetes 1-month low-grade fever.
Getting hemodialysis for end-stage renal disease. T 37 C (98.6 F), pulse
72, bp 144/92. Physical subclavian catheter below right clavicle. Lungs
clear. Cardiac exam no murmurs. Blood cultures grow nonhemolytic,
,catalase-negative, gram-positive cocci in pairs and chains. Which
organism? - ANSWER- Enterococcus faecalis
3yo boy sickle cell disease with fever and pain over left foot 3 weeks.
Hematocrit stable. Leukocyte count 15,000 predominance of
neutrophils. Which is most likely explanation for findings? - ANSWER-
osteomyelitis
10yo girl well-child examination. No menstrual period. 50th percentile
height and weight. Physical exam absence of breast bud development
and no pubic or axillary hair. It is most appropriate to tell mother that
first objective sign of puberty will be which? - ANSWER- Breast bud
development
45yo woman follow-up exam after 8 weeks tamoxifen therapy for
estrogen and progesterone positive invasive ductal carcinoma of breast.
50yo sister also hormone-sensitive breast cancer. Physical exam normal.
Serum decreased concentrations of endoxifen, active metabolite of
prodrug tamoxifen. Genetic analysis shows homozygous cytochrome
P450 2D6*4 alleles. Likelihood patient's sisters has same alleles? -
ANSWER- 25%
60yo man progressive shortness of breath past 3 months. Worked in
shipyard. Respirations 25. Bilateral basilar crepitant crackles. Xray chest
reticulonodular pulmonary infiltrates consistent with interstitial fibrosis.
Picture: sputum sample of elongate structures (ferruginous body).
Fibrosis initiated by interaction of structures with which cell? -
ANSWER- Alveolar macrophages
,30yo woman 20 weeks gestation, uncomplicated pregnancy. Fundal
height is greater than expected for gestational age. Ultrasound shows
increased amniotic fluid. Which abnormality is cause? - ANSWER-
Tracheoesophageal atresia
43yo woman for health maintenance exam. Physician 30 minutes late for
appointment because of emergency, when enters, patients checks watch.
Which is best initial response? - ANSWER- "I'm sorry I got delayed. I
hope I haven't made you late somewhere else."
27yo woman 12-hour history of fever and abdominal pain. History of
recurrent urinary tract infections. Temperature is 39 C (102.2 F).
Physical exam tenderness of right flank. Abdominal xrays bilateral
staghorn renal calculi. Urinalysis pH 8, many RBCs, WBC, bacteria.
Calculi composed of? - ANSWER- struvite
48yo nulligravid woman with excessive uterine bleeding for 3 months.
Bleeding during menses and at irregular intervals. Menses were regular
before. BMI 27. Pelvic exam: adnexae are nonpalpable. Endometrial
curettage shows abundant tissue. Which is cause of symptoms? -
ANSWER- Endometrial hyperplasia
65yo woman surgical repair of aneurysm right internal carotid artery in
cavernous sinus. Three days later on physical exam, right pupil larger
than left pupil. Weakness of eye movement. Diagram of coronal section
through middle cranial fossa shown. Which nerve is damaged? -
ANSWER- A (CN III)
55yo woman 6-week history low energy, irritability, crying spells,
difficulty falling asleep, wakes up during night, cannot focus. Taking
lorazepam for 15y for generalized anxiety disorder. Taking estrogen
, replacement therapy for postmenopausal symptoms. Vital signs normal.
Physical exam normal. Mental status shows constricted affect. Mood is
"testy." Speech is slowed. No psychosis. Wishes she wouldn't wake up
but doesn't plan to harm herself. Cause of symptoms? - ANSWER-
Major depressive disorder
10yrs after total gastrectomy, 60yo man difficulty walking. Diffuse
spasticity in arms and legs, impaired proprioception in his feet, increased
muscle stretch reflexes in arms and knees, absence of muscle stretch
reflexes in ankles, bilateral extensor plantar responses. Which vitamin is
deficient? - ANSWER- B12 (cobalamin)
80yo man type 2 diabetes 2-month history severe constipation. Laxatives
haven't relieved symptoms. Abdominal exam shows distention.
Colonoscopy shows no abnormalities. Patient has dysfunction of which
nerve? - ANSWER- Pelvic splanchnic
34yo man lightheaded after running 12 miles of marathon hot day. Pulse
130 bp 80/60. Which changes to autonomic nervous system occurred? -
ANSWER- B. Sympathetic efferent activity increased, parasympathetic
efferent activity decreased
6-Mercaptopurine (6-MP) used to treat acute lymphoblastic leukemia
(ALL). 6-MP acted on by enzymes to make 6-thioguanine nucleotides
(6-TGN). Efficacy and toxicity of 6-MP correlated with 6-TGN. 6-MP
acted on by xanthine oxidase (XO), thiopurine methyltransferase
(TPMT), leading to inactive metabolites. Which are clinical
consequences of ALL patients homozygous for low-activity alleles of
TPMT? - ANSWER- They may be given normal doses of 6-MP (?)
