NBME CBSE ACTUAL TEST QUESTIONS AND ANSWERS (Quiz bank with all the correct answers) (usmle step 1) Medical examination

62 year old woman - osteoporosis - a bisphosphonate is prescribed. The expected beneficial effect of the drug is due to which of the following? -Answer- 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? -AnswerStatistically 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? -Answer- 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? -Answera. 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? - Answer- 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? -Answer- 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? -Answer- 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? -AnswerInfectious 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -AnswerVitamin 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? -Answer- 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? -Answer- 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? -Answer- Submental 15 year old boy - ER - 2 hour history of confusion and agitation - fever, headache, stiff neck, and vomiting - since returned from summer camp - patient is hallucinating - lumbar puncture - shows cysts and trophozoites- most likely pathogen? -Answer- a. Olfactory Nerve Naegleria fowleri 17 year old - ED - 30 minutes after being found with a blank stare. Physical exam shows rigidity. During exam he becomes hostile and assaults physician - Pt ingested which drug? -Answer- PCP Placebo controlled clinical trial - 5000 pts with essential hypertension. 2500 patients receive new drug and 2500 patients receive placebo. If alpha is set at 0.01 instead of 0.05, which of the following is most likely result? -Answer- Significant findings can be reported with greater confidence 17 year old - gymnast - comes to hospital because of lack of menstrual period for 6 months. BMI 15 Which is the cause of the amenorrhea? -Answer- Hypogonadotropic Hypogonadism A male stillborn is delivered at 32 weeks - Oligohydramnios - absence of a urethral opening. Which is most likely finding? -Answer- Pulmonary Hypoplasia A 6 day old - breast fed boy in ED - poor weight gain and irritability since delivery - Physical exam shows jaundice and hepatomegaly. The concentration of which of the following metabolites is most likely increased? -Answer- a. Galactose - 1 - phosphate b. Congenital intolerance to breast milk A 25-year-old man - comes to ED - severe muscle pain, diffuse, painful swelling of his neck, underarms, and groin after camping in New Mexico Generalized scattered black maculae. Examination of the right upper extremity shows erythematous, solid, tender mass. Mass is draining blood and necrotic material. The most effective antibiotic for patient disorder will interfere with which of the following processes? -Answer- a. Ribosomal Assembly b. Yersenia Pestis 45 year old - progressive weakness - muscle fasciculations of the upper extremities and weakness of the lower extremity - What additional findings? -Answer- Atrophy b. ALS = Lou Gherig A new severe respiratory illness - Why use a killed vaccine vs a live vaccine? -AnswerAvoids Concerns of reversion to virulence b. Killed vaccines - avoids reversion to virulence c. live vaccines - can (but rarely do) cause the disease they're designed to prevent A 33 year old - keratinizing squamous cell carcinoma of cervix. Which of the following describes pathogenesis of this patient's disease? -Answer- Inactivation of Cellular P53 b. p53 protein = tumor suppressor (it activates apoptosis) - most human cancer A 54 year old - 40 year history of T1DM - receiving hemodialysis for end stage renal disease while awaiting a kidney transplant. Receives a drug that induces reticulocyte release from bone marrow and stimulates a cytokine receptor that signals Jak/Stat pathway? -Answer- Erythropoietin Jak Stat - erythropoietin During a clinical study examining the effects of exercise. The average pulse is 175/min. Compared with measurement before the session, which is most likely decreased? - Answer- Total Peripheral Resistance An 8-year-old boy - 3-day history of fever, sore throat, and itchy eyes. Returned from week long summer camp that includes hiking trips and swimming - PE shows conjunctival injection and oropharyngeal edema - Outbreak among other campers. Which is most likely cause of this patient's symptoms? -Answer- Adenovirus Fever+ Sore Throat + Itchy Eyes transmitted via swimming pools Conjunctivitis Viral = adenovirus 44-year-old woman - 10 month history of wide red streaks over her lower trunk (striae) and weight gain in face (moonface). Which additional findings? -Answer- Hypertension and muscle weakness b. Cushing - hypertension and muscle weakness 12 year old boy - pain below left knee -unable to play soccer - An x-ray shown - Which structures attached to the abnormal anterior tibial area? -Answer- patellar ligament b. Osgood-Schlatter A 65-year-old health maintenance exams - He lives is a single-family home with his cat and dog. He spend much of his time in his