/NBME CBSE (usmle step 1)MEDICAL ACTUAL EXAM
NEWEST VERSION 2024-2025 TESTBANK QUESTIONS AND
CORRECT DETAILEDANSWERS WITH RATIONALES
|ALREADYGRADED A+
. 60yo M from china to USA with 1-month hx of confusion and swelling of abdomen and legs.
M M M M M M M M M M M M M M M M M
MPeanut farmer in china. Smoked 1 pack per day for 40 years. No alcohol. PE shows ascites and
M M M M M M M M M M M M M M M M M
Mankle edema. Liver palpable, spleen isn't.
M M M M M
Serum: Albumin 4, total bili 2.5, Alk Phos 200, AST 45, ALT 60, IgG anti Hep A positive; Anti hep B
M M M M M M M M M M M M M M M M M M M M
Mnegative, anti hep C negative. U/S shows 10 cm lesion. Biopsy shows dysplastic hepatocytes in
M M M M M M M M M M M M M M
Msmall clusters and rows with no normal architecture. Exposure to which? - ANSW -Aflatoxin
M M M M M M M M M M M M M
"-azosin" - ANSW -a1 block M M M M M
tx BPH and HTN
M M M
"-tidine" - ANSW -H2 antagonist
M M M M
decrease H from parietal M M M
"prazole" - ANSW -PPI M M M M
inhibit *H/K ATPase* in parietal cell
M M M M M
*APC/B cat* tumor suppressor found in what cancer - ANSW -Colorectal
M M M M M M M M M M
Pancreatic
*Cellular* Acute Transplant rejection - ANSW -*lymphocytic* endothelitis
M M M M M M M
*EPO released in kidney*
M M M
Caused by: M
Causes: - ANSW -Caused by: *hypoxia* sensed by
M M M M M M M M
peritubular renal cortex M M
Causes: *pulmonary HTN*
M M
*PD-1* on T cell does what - ANSW -inhibit CD8
M M M M M M M M M
,(*cancer tx = Ab against PD-1)
M M M M M
*Rb* tumor suppressor - ANSW -Retinoblastoma
M M M M M
Osteosarcoma
*Vesicoureteral Reflux* can cause what in a child - ANSW -HTN
M M M M M M M M M M
#1 causes of DVT/PE - ANSW -Malignancy and smoking (*hypercoagulable)
M M M M M M M M M
#1 lung cancer - ANSW -Adenocarcinoma
M M M M M
%K in tubules - ANSW -100% glomeruli
M M M M M M M
35% PCT M
10% thick loop M M
110% CD M
+ Babinski means there is a - ANSW -UMN lesion
M M M M M M M M M
hyperreflexia +3 M M
Dorsiflex w stroke of plantar of foot
M M M M M M
>3 d starve uses - ANSW -Adipose
M M M M M M
Ketones (leu and Lys) M M M
1-3 d starve causes - ANSW -*FFA* (hormone sensitive lipase)
M M M M M M M M M
- *epi* stimulates
M M
*Gluconeogensis *(Cortisol; OAA --> PEP) M M M M
1-a-hydroxylase in macrophages - ANSW -PTH independent conversion of
M M M M M M M M M
Calcifediol to *calcitriol* (bioactive Vit D)
M M M M M
Vit D --> Hyper Ca
M M M M
1-week-old girl. screening showed a possible defect in fatty acid oxidation. PE normal. Next step? -
M M M M M M M M M M M M M M M
MANSW -Measurement of serum acylcarnitine concentrations
M M M M M
1* Hyperaldosteronism - ANSW -increased mineralocorticoids (Zona G)
M M M M M M M
,--> decreased *renin* (HTN)
M M M
--> decreased *K* (paresthesia)
M M M
--> increased *HCO3*
M M
1* Hyperparathyroid levels - ANSW -high PTH
M M M M M M
high Ca M
low PO4 M
high Ca = stones thrones groans psych overtones
M M M M M M M
10yo boy has had anemia since birth. Spleen is five times normal. Splenectomy is indicated if
M M M M M M M M M M M M M M M
Manemia is caused by which? - ANSW -Hereditary spherocytosis
M M M M M M M M
10yo girl well-child examination. No menstrual period. 50th percentile height and weight. Physical
M M M M M M M M M M M M
Mexam absence of breast bud development and no pubic or axillary hair. It is most appropriate to
M M M M M M M M M M M M M M M M
Mtell mother that first objective sign of puberty will be which? - ANSW -Breast bud development
M M M M M M M M M M M M M M M
10yrs after total gastrectomy, 60yo man difficulty walking. Diffuse spasticity in arms and legs,
M M M M M M M M M M M M M
Mimpaired proprioception in his feet, increased muscle stretch reflexes in arms and knees, absence
M M M M M M M M M M M M M
Mof muscle stretch reflexes in ankles, bilateral extensor plantar responses. Which vitamin is
M M M M M M M M M M M M
Mdeficient? - ANSW -B12 (cobalamin) M M M M
11:14 - ANSW -Mantle
M M M
cyclin D = G1-->S
M M M
12:21 - ANSW -ALL child
M M M M
12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological changes? - ANSW -
M M M M M M M M M M M M M M M M M
Central blood volume INCREASED, ADH (vasopressin) DECREASED, Atrial Natriuretic Peptide
M M M M M M M M M
MINCREASED? C (block3, q23) M M M
13yo girl 2/6, holosystolic murmur heard best over left fifth intercostal space adjacent to the
M M M M M M M M M M M M M M
Msternum; it increases with inspiration. Abnormality of which valves? - ANSW -Tricuspid
M M M M M M M M M M M
14:11 - ANSW -Follicular
M M M
Bcl2 = apoptosis
M M
14yo boy come to ER 1 hour after colliding with teammate playing soccer. Physical exam:
M M M M M M M M M M M M M M
Medematous tissues of left eye, mild depression of left zygomatic bone. Skin between eye and
M M M M M M M M M M M M M M
Mupper lip numb. Double vision look upward. Nerve damaged causing sensory loss? - ANSW -
M M M M M M M M M M M M M M
Maxillary division of trigeminal nerve
M M M M
, 14yo boy daily headaches for 2 months. Headaches are bilateral aching in temples. "Has not been
M M M M M M M M M M M M M M M
Mhimself" for months. Confused, forgetting names, dates, places, clumsy, frequent falls. School
M M M M M M M M M M M
Mperformance declined. Physical exam: broad-based ataxic gait. Slow to answer questions. Chronic
M M M M M M M M M M M
Mabuse of which substance? - ANSW -Inhaled glue
M M M M M M M
15:17 - ANSW -AML
M M M M
retinoic acid M
15yo girl 1-day hx redness and painful skin following sunbathing. She used sunblock. No
M M M M M M M M M M M M M
Mmedications. Physical exam: severe erythema of back and extremities, no blisters. Dx? - ANSW -
M M M M M M M M M M M M M M
First-degree burn M
15yo girl emigrated from India and with several lesions on neck for 2 weeks. Physical exam shows
M M M M M M M M M M M M M M M M
Mhypopigmented, hypoesthetic area on left side of forehead and 4-cm lesions on neck. Biopsy
M M M M M M M M M M M M M
Mshows acid-fast bacilli. Best explanation why the organism results in dermal rather than visceral
M M M M M M M M M M M M M
Minfections? - ANSW -Temperature sensitivity
M M M M
15yo girl health maintenance exam. Mother dx squamous cell carcinoma face, maternal
M M M M M M M M M M M
Mgrandfather died of metastatic melanoma. In patient this age, which factor most predicts
M M M M M M M M M M M M
Mcompliance with photoprotection? - ANSW -Use of sunscreen by her peers
M M M M M M M M M M
16yo boy with no signs of puberty. Sex development Tanner stage 2. Physical exam: circumcised
M M M M M M M M M M M M M M
Mpenis, soft small tests 5 mL, prostate firm, nontender, no discharge or lesions. Testosterone low.
M M M M M M M M M M M M M M
MWhich hormone is cause of decreased serum testosterone and lack of pituitary hormone stimulus?
M M M M M M M M M M M M M
M- ANSW -Luteinizing hormone
M M M
16yo girl with 2-year hx of fainting; increased in frequency during past 6 months. BP 110/80
M M M M M M M M M M M M M M M
Msupine and 60/40 standing. Neuro exam normal. Plasma shows undetectable norepinephrine and
M M M M M M M M M M M
Mmarked increase in dopamine concentration when standing. Deficiency of which? - ANSW -
M M M M M M M M M M M M
Dopamine beta-hydroxylase M
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P 88/min, BP 102-70.
M M M M M M M M M M M M M M M M
MPE shows pale conjunctivae. CXR shows bilateral interstitial infiltrates. Blood spontaenously
M M M M M M M M M M
Magglutinates while awaiting transport to the laboratory. Antibody isotypes causing agglutination? -
M M M M M M M M M M M
MANSW -IgM M
17yo boy with 8-kg weight gain during the past year. No medical illness. BMI is 32. He asks, "Do
M M M M M M M M M M M M M M M M M M
Myou think that my weight gain is inherited from my father?" Appropriate response? - ANSW -"Yes,
M M M M M M M M M M M M M M M
Myour weight gain can be caused by genes and environment combined."
M M M M M M M M M M
17yo girl 1-day shortness of breath, weakness and muscle tenderness. Did triathlon previous day.
M M M M M M M M M M M M M
MBMI 19. Temperature 38 C (100.4 F), respirations 20, bp 150/90. Physical bilateral crackles lower
M M M M M M M M M M M M M M
Mlobes, muscle tenderness. Creatinine 4. Urinalysis 3+ protein, 4+ hemoglobin. Patient's condition is
M M M M M M M M M M M M
Mfrom increased release of which substance? - ANSW -Myoglobin
M M M M M M M M
NEWEST VERSION 2024-2025 TESTBANK QUESTIONS AND
CORRECT DETAILEDANSWERS WITH RATIONALES
|ALREADYGRADED A+
. 60yo M from china to USA with 1-month hx of confusion and swelling of abdomen and legs.
M M M M M M M M M M M M M M M M M
MPeanut farmer in china. Smoked 1 pack per day for 40 years. No alcohol. PE shows ascites and
M M M M M M M M M M M M M M M M M
Mankle edema. Liver palpable, spleen isn't.
M M M M M
Serum: Albumin 4, total bili 2.5, Alk Phos 200, AST 45, ALT 60, IgG anti Hep A positive; Anti hep B
M M M M M M M M M M M M M M M M M M M M
Mnegative, anti hep C negative. U/S shows 10 cm lesion. Biopsy shows dysplastic hepatocytes in
M M M M M M M M M M M M M M
Msmall clusters and rows with no normal architecture. Exposure to which? - ANSW -Aflatoxin
M M M M M M M M M M M M M
"-azosin" - ANSW -a1 block M M M M M
tx BPH and HTN
M M M
"-tidine" - ANSW -H2 antagonist
M M M M
decrease H from parietal M M M
"prazole" - ANSW -PPI M M M M
inhibit *H/K ATPase* in parietal cell
M M M M M
*APC/B cat* tumor suppressor found in what cancer - ANSW -Colorectal
M M M M M M M M M M
Pancreatic
*Cellular* Acute Transplant rejection - ANSW -*lymphocytic* endothelitis
M M M M M M M
*EPO released in kidney*
M M M
Caused by: M
Causes: - ANSW -Caused by: *hypoxia* sensed by
M M M M M M M M
peritubular renal cortex M M
Causes: *pulmonary HTN*
M M
*PD-1* on T cell does what - ANSW -inhibit CD8
M M M M M M M M M
,(*cancer tx = Ab against PD-1)
M M M M M
*Rb* tumor suppressor - ANSW -Retinoblastoma
M M M M M
Osteosarcoma
*Vesicoureteral Reflux* can cause what in a child - ANSW -HTN
M M M M M M M M M M
#1 causes of DVT/PE - ANSW -Malignancy and smoking (*hypercoagulable)
M M M M M M M M M
#1 lung cancer - ANSW -Adenocarcinoma
M M M M M
%K in tubules - ANSW -100% glomeruli
M M M M M M M
35% PCT M
10% thick loop M M
110% CD M
+ Babinski means there is a - ANSW -UMN lesion
M M M M M M M M M
hyperreflexia +3 M M
Dorsiflex w stroke of plantar of foot
M M M M M M
>3 d starve uses - ANSW -Adipose
M M M M M M
Ketones (leu and Lys) M M M
1-3 d starve causes - ANSW -*FFA* (hormone sensitive lipase)
M M M M M M M M M
- *epi* stimulates
M M
*Gluconeogensis *(Cortisol; OAA --> PEP) M M M M
1-a-hydroxylase in macrophages - ANSW -PTH independent conversion of
M M M M M M M M M
Calcifediol to *calcitriol* (bioactive Vit D)
M M M M M
Vit D --> Hyper Ca
M M M M
1-week-old girl. screening showed a possible defect in fatty acid oxidation. PE normal. Next step? -
M M M M M M M M M M M M M M M
MANSW -Measurement of serum acylcarnitine concentrations
M M M M M
1* Hyperaldosteronism - ANSW -increased mineralocorticoids (Zona G)
M M M M M M M
,--> decreased *renin* (HTN)
M M M
--> decreased *K* (paresthesia)
M M M
--> increased *HCO3*
M M
1* Hyperparathyroid levels - ANSW -high PTH
M M M M M M
high Ca M
low PO4 M
high Ca = stones thrones groans psych overtones
M M M M M M M
10yo boy has had anemia since birth. Spleen is five times normal. Splenectomy is indicated if
M M M M M M M M M M M M M M M
Manemia is caused by which? - ANSW -Hereditary spherocytosis
M M M M M M M M
10yo girl well-child examination. No menstrual period. 50th percentile height and weight. Physical
M M M M M M M M M M M M
Mexam absence of breast bud development and no pubic or axillary hair. It is most appropriate to
M M M M M M M M M M M M M M M M
Mtell mother that first objective sign of puberty will be which? - ANSW -Breast bud development
M M M M M M M M M M M M M M M
10yrs after total gastrectomy, 60yo man difficulty walking. Diffuse spasticity in arms and legs,
M M M M M M M M M M M M M
Mimpaired proprioception in his feet, increased muscle stretch reflexes in arms and knees, absence
M M M M M M M M M M M M M
Mof muscle stretch reflexes in ankles, bilateral extensor plantar responses. Which vitamin is
M M M M M M M M M M M M
Mdeficient? - ANSW -B12 (cobalamin) M M M M
11:14 - ANSW -Mantle
M M M
cyclin D = G1-->S
M M M
12:21 - ANSW -ALL child
M M M M
12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological changes? - ANSW -
M M M M M M M M M M M M M M M M M
Central blood volume INCREASED, ADH (vasopressin) DECREASED, Atrial Natriuretic Peptide
M M M M M M M M M
MINCREASED? C (block3, q23) M M M
13yo girl 2/6, holosystolic murmur heard best over left fifth intercostal space adjacent to the
M M M M M M M M M M M M M M
Msternum; it increases with inspiration. Abnormality of which valves? - ANSW -Tricuspid
M M M M M M M M M M M
14:11 - ANSW -Follicular
M M M
Bcl2 = apoptosis
M M
14yo boy come to ER 1 hour after colliding with teammate playing soccer. Physical exam:
M M M M M M M M M M M M M M
Medematous tissues of left eye, mild depression of left zygomatic bone. Skin between eye and
M M M M M M M M M M M M M M
Mupper lip numb. Double vision look upward. Nerve damaged causing sensory loss? - ANSW -
M M M M M M M M M M M M M M
Maxillary division of trigeminal nerve
M M M M
, 14yo boy daily headaches for 2 months. Headaches are bilateral aching in temples. "Has not been
M M M M M M M M M M M M M M M
Mhimself" for months. Confused, forgetting names, dates, places, clumsy, frequent falls. School
M M M M M M M M M M M
Mperformance declined. Physical exam: broad-based ataxic gait. Slow to answer questions. Chronic
M M M M M M M M M M M
Mabuse of which substance? - ANSW -Inhaled glue
M M M M M M M
15:17 - ANSW -AML
M M M M
retinoic acid M
15yo girl 1-day hx redness and painful skin following sunbathing. She used sunblock. No
M M M M M M M M M M M M M
Mmedications. Physical exam: severe erythema of back and extremities, no blisters. Dx? - ANSW -
M M M M M M M M M M M M M M
First-degree burn M
15yo girl emigrated from India and with several lesions on neck for 2 weeks. Physical exam shows
M M M M M M M M M M M M M M M M
Mhypopigmented, hypoesthetic area on left side of forehead and 4-cm lesions on neck. Biopsy
M M M M M M M M M M M M M
Mshows acid-fast bacilli. Best explanation why the organism results in dermal rather than visceral
M M M M M M M M M M M M M
Minfections? - ANSW -Temperature sensitivity
M M M M
15yo girl health maintenance exam. Mother dx squamous cell carcinoma face, maternal
M M M M M M M M M M M
Mgrandfather died of metastatic melanoma. In patient this age, which factor most predicts
M M M M M M M M M M M M
Mcompliance with photoprotection? - ANSW -Use of sunscreen by her peers
M M M M M M M M M M
16yo boy with no signs of puberty. Sex development Tanner stage 2. Physical exam: circumcised
M M M M M M M M M M M M M M
Mpenis, soft small tests 5 mL, prostate firm, nontender, no discharge or lesions. Testosterone low.
M M M M M M M M M M M M M M
MWhich hormone is cause of decreased serum testosterone and lack of pituitary hormone stimulus?
M M M M M M M M M M M M M
M- ANSW -Luteinizing hormone
M M M
16yo girl with 2-year hx of fainting; increased in frequency during past 6 months. BP 110/80
M M M M M M M M M M M M M M M
Msupine and 60/40 standing. Neuro exam normal. Plasma shows undetectable norepinephrine and
M M M M M M M M M M M
Mmarked increase in dopamine concentration when standing. Deficiency of which? - ANSW -
M M M M M M M M M M M M
Dopamine beta-hydroxylase M
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P 88/min, BP 102-70.
M M M M M M M M M M M M M M M M
MPE shows pale conjunctivae. CXR shows bilateral interstitial infiltrates. Blood spontaenously
M M M M M M M M M M
Magglutinates while awaiting transport to the laboratory. Antibody isotypes causing agglutination? -
M M M M M M M M M M M
MANSW -IgM M
17yo boy with 8-kg weight gain during the past year. No medical illness. BMI is 32. He asks, "Do
M M M M M M M M M M M M M M M M M M
Myou think that my weight gain is inherited from my father?" Appropriate response? - ANSW -"Yes,
M M M M M M M M M M M M M M M
Myour weight gain can be caused by genes and environment combined."
M M M M M M M M M M
17yo girl 1-day shortness of breath, weakness and muscle tenderness. Did triathlon previous day.
M M M M M M M M M M M M M
MBMI 19. Temperature 38 C (100.4 F), respirations 20, bp 150/90. Physical bilateral crackles lower
M M M M M M M M M M M M M M
Mlobes, muscle tenderness. Creatinine 4. Urinalysis 3+ protein, 4+ hemoglobin. Patient's condition is
M M M M M M M M M M M M
Mfrom increased release of which substance? - ANSW -Myoglobin
M M M M M M M M
