NBME CBSE REAL EXAM 200
QUESTIONS AND ANSWERS LATEST
MEDICAL EXAMINATION
1) A 16-year-old boy is brought to the emergency department 20 minutes after the onset
of a generalized tonic-clonic seizure lasting 5 minutes. He has hypertension treated
with a calcium-channel blocking agent, but he has not been taking his medication. On
arrival, he is unarousable. His blood pressure is 250/154mmHg. Examination shows
proliferative retinopathy. Urinalysis shows 1+ protein. Which of the following is the most
appropriate intravenous pharmacotherapy.
A. Diazoxide
B. Furosemide
C. Hydralazine
D. Lorazepam
E. Sodium nitroprusside – ANSWER -E! Very high yield question: know the anti-
hypertensives used for hypertensive emergency (eg encephalopathy)
2) A 3-year-old boy is brought to the emergency department because of a 1-day history
of fever, abdominal pain, and diarrhea containing blood and mucous. He has a history
of recurrent ear infections treated with antibiotics. He completed a 10-day course of
amoxicillin-clavulanate 1 day ago. He appears moderately ill. His temperature is 38.4C,
pulse is 104/min, respirations are 20/min, and blood pressure is 100/62mmHg.
Abdominal examination shows moderate left lower quadrant tenderness with no
rebound. The remainder of the examination shows no abnormalities. Test of the stool for
occult blood is positive. Which of the following is the most likely causal organism?
A. Clostridium difficile
,B. Salmonella enteritidis
C. Shigella sonnei
D. Staphylococcus aureus
E. Yersinia enterocolitica – ANSWER -Post-antibiotic diarrhea: C. Diff
Interesting to recognize that it can be bloody, mucus, and can occur after amoxicillin
3) A 3-month-old boy is brought to the physician by his mother because of a 1-day
history of fever, vomiting, and fussiness. He was born at 39 weeks gestation following an
uncomplicated pregnancy and delivery. He is alert and mildly irritable but easily
consoled by his mother. His rectal temperature is 39C, pulse is 160/min, and
respirations are 38/min. Examination of the skin shows no abnormalities. The tympanic
membranes are mildly erythematous with normal landmarks and motility. The lungs are
clear to auscultation. The abdomen is soft with no palpable masses. The patient is
uncircumcised. Laboratory studies show:
Hemoglobin 11.9 g/dL
Leukocyte count 12,200/mm3
Platelet count 240,000/mm3
Urine:
Nitrites 2+
Leukocyte esterase 3+
Results of blood and urine cultures are pending. Which of the following is the most
appropriate pharmacotherapy?
A. Cefazolin
B. Cefotaxime
C. Nafcillin
D. Penicillin
E. Vancomycin – ANSWER -Of these, 3rd gen cephalosporins are the best for empiric
therapy. Caution with ceftriaxone (it can cause hyperbilirubinemia – may not be a
concern in this kid). Cefotaxime is the best choice
, 4) A 3-year-old boy is brought for a well-child examination. His mother states that his
belly seems big. His vital signs are within normal limits. Examination shows aniridia.
There is a palpable mass in the right flank. The remainder of the examination shows no
abnormalities. Which of the following is the most appropriate next step in diagnosis?
A. Measurement of serum catecholamine concentration
B. Measurement of urine vanillylmandelic acid and homovanillic acid concentrations
(wrong choice)
C. X-ray of the abdomen
D. X-ray of the chest
E. Ultrasonography of the abdomen – ANSWER -WAGR syndrome -> abdominal US to
detect Wilms tumor
5) A 5-year-old boy is brought to the physician because of a 4-day history of increasing
difficulty breathing. His temperature is 37.5C, pulse is 116/min, respirations are 36/min,
and blood pressure is 116/80mmHg. Examination shows jugular venous distention and
mild swelling of the face and upper extremities. There are moderate intercostal
retractions. Inspiratory and expiratory wheezes are heard bilaterally. An x-ray of the
chest shows a mass in the superior mediastinum and a large pleural effusion in the right
hemithorax. Thoracentesis yields 400mL of reddish brown serosanguineous fluid
containing numerous erythrocytes. Which of the following is the most likely cause of the
pleural effusion?
A. Congestive heart failure
B. Malignant pleural effusion
C. Nephrotic syndrome
D. Traumatic hemothorax
E. Tuberculous pleural effusion – ANSWER -Serosanguinous pleural effusions are
always malignant! This is a very classic presentation for non-Hodgkin’s lymphoma
(which is often an anterior mediastinal mass that can cause painless LAD, SVC
syndrome, and respiratory distress – per BRS)
A 4-day-old newborn is brought to the physician b/c of a 2-day history of progressive
jaundice. He was born at 36 weeks’ gestation to a 27-year-old woman, gravid2, para 2,
following an uncomplicated pregnancy and delivery and weighed 2608 g(5lb 12oz). The
newborn’s blood group is O, Rh-positive, and the mother’s blood group is B, Rh-positive.
QUESTIONS AND ANSWERS LATEST
MEDICAL EXAMINATION
1) A 16-year-old boy is brought to the emergency department 20 minutes after the onset
of a generalized tonic-clonic seizure lasting 5 minutes. He has hypertension treated
with a calcium-channel blocking agent, but he has not been taking his medication. On
arrival, he is unarousable. His blood pressure is 250/154mmHg. Examination shows
proliferative retinopathy. Urinalysis shows 1+ protein. Which of the following is the most
appropriate intravenous pharmacotherapy.
A. Diazoxide
B. Furosemide
C. Hydralazine
D. Lorazepam
E. Sodium nitroprusside – ANSWER -E! Very high yield question: know the anti-
hypertensives used for hypertensive emergency (eg encephalopathy)
2) A 3-year-old boy is brought to the emergency department because of a 1-day history
of fever, abdominal pain, and diarrhea containing blood and mucous. He has a history
of recurrent ear infections treated with antibiotics. He completed a 10-day course of
amoxicillin-clavulanate 1 day ago. He appears moderately ill. His temperature is 38.4C,
pulse is 104/min, respirations are 20/min, and blood pressure is 100/62mmHg.
Abdominal examination shows moderate left lower quadrant tenderness with no
rebound. The remainder of the examination shows no abnormalities. Test of the stool for
occult blood is positive. Which of the following is the most likely causal organism?
A. Clostridium difficile
,B. Salmonella enteritidis
C. Shigella sonnei
D. Staphylococcus aureus
E. Yersinia enterocolitica – ANSWER -Post-antibiotic diarrhea: C. Diff
Interesting to recognize that it can be bloody, mucus, and can occur after amoxicillin
3) A 3-month-old boy is brought to the physician by his mother because of a 1-day
history of fever, vomiting, and fussiness. He was born at 39 weeks gestation following an
uncomplicated pregnancy and delivery. He is alert and mildly irritable but easily
consoled by his mother. His rectal temperature is 39C, pulse is 160/min, and
respirations are 38/min. Examination of the skin shows no abnormalities. The tympanic
membranes are mildly erythematous with normal landmarks and motility. The lungs are
clear to auscultation. The abdomen is soft with no palpable masses. The patient is
uncircumcised. Laboratory studies show:
Hemoglobin 11.9 g/dL
Leukocyte count 12,200/mm3
Platelet count 240,000/mm3
Urine:
Nitrites 2+
Leukocyte esterase 3+
Results of blood and urine cultures are pending. Which of the following is the most
appropriate pharmacotherapy?
A. Cefazolin
B. Cefotaxime
C. Nafcillin
D. Penicillin
E. Vancomycin – ANSWER -Of these, 3rd gen cephalosporins are the best for empiric
therapy. Caution with ceftriaxone (it can cause hyperbilirubinemia – may not be a
concern in this kid). Cefotaxime is the best choice
, 4) A 3-year-old boy is brought for a well-child examination. His mother states that his
belly seems big. His vital signs are within normal limits. Examination shows aniridia.
There is a palpable mass in the right flank. The remainder of the examination shows no
abnormalities. Which of the following is the most appropriate next step in diagnosis?
A. Measurement of serum catecholamine concentration
B. Measurement of urine vanillylmandelic acid and homovanillic acid concentrations
(wrong choice)
C. X-ray of the abdomen
D. X-ray of the chest
E. Ultrasonography of the abdomen – ANSWER -WAGR syndrome -> abdominal US to
detect Wilms tumor
5) A 5-year-old boy is brought to the physician because of a 4-day history of increasing
difficulty breathing. His temperature is 37.5C, pulse is 116/min, respirations are 36/min,
and blood pressure is 116/80mmHg. Examination shows jugular venous distention and
mild swelling of the face and upper extremities. There are moderate intercostal
retractions. Inspiratory and expiratory wheezes are heard bilaterally. An x-ray of the
chest shows a mass in the superior mediastinum and a large pleural effusion in the right
hemithorax. Thoracentesis yields 400mL of reddish brown serosanguineous fluid
containing numerous erythrocytes. Which of the following is the most likely cause of the
pleural effusion?
A. Congestive heart failure
B. Malignant pleural effusion
C. Nephrotic syndrome
D. Traumatic hemothorax
E. Tuberculous pleural effusion – ANSWER -Serosanguinous pleural effusions are
always malignant! This is a very classic presentation for non-Hodgkin’s lymphoma
(which is often an anterior mediastinal mass that can cause painless LAD, SVC
syndrome, and respiratory distress – per BRS)
A 4-day-old newborn is brought to the physician b/c of a 2-day history of progressive
jaundice. He was born at 36 weeks’ gestation to a 27-year-old woman, gravid2, para 2,
following an uncomplicated pregnancy and delivery and weighed 2608 g(5lb 12oz). The
newborn’s blood group is O, Rh-positive, and the mother’s blood group is B, Rh-positive.
