NBME CBSE REAL EXAM 200
QUESTIONS AND ANSWERS LATEST
2023-2024 (usmle step 1)MEDICAL
EXAMINATION
70yo M dies in a motor vehicle collision. Was undergoing evaluation for
occult blood in the stool. Photo of transverse colon shown. Dx? -
ANSWER- Tubular adenoma
38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical
shows inflamed nasal mucosa. No congestion in lower lung.
Pharmacotherapy? - ANSWER- Loratadine
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T
38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR shows
bilateral interstitial infiltrates. Blood spontaenously agglutinates while
awaiting transport to the laboratory. Antibody isotypes causing
agglutination? - ANSWER- IgM
24yo M with small tender blisters on his penis 3 days after unprotected
sex. Photograph shown. Causal agent? - ANSWER- HSV-2
42yo F with 3-year hx of an intermittent facial rash, including the
forehead, eyelids, nose, and cheeks. Rash seems to be getting worse
since she moved from New York to Florida last year. Spicy foods
precipitate a flushing reaction that seems to exacerbate the rash. PE
shows erythema over the nose and cheeks, with scattered telangiectasias
and a few papules. Dx? - ANSWER- Rosacea
,53yo M returned from Africa, has fever, headache, and abdominal
discomfort. Received appropriate vaccinations prior to the trip. T 39.4C.
A wright-stained peripheral smear shown. Dx? - ANSWER- Malaria
68yo F with T2DM and hypertension that has been poorly controlled
despite hydrochlorothiazide treatment. BP 150/96, Labs show serum
glucose concentration of 130 and proteinuria. In addition to current Rx,
which is most appropriate pharmacotherapy? - ANSWER- Lisinopril
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea
after receiving chemotherapy with fluorouracil, leucovorin, and
Irinotecan. prescribed opioid antidiarrheal agent with no CNS effects.
Which med? - ANSWER- Loperamide
35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had
profuse, watery diarrhea for 8 hours despite a lack of oral intake.
Recently returned from a medical relief trip to a remove village in
Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin and
decreased capillary refill. Stool for occult blood is negative; stool is gray
and turbid. Gram stain shows gram-negative, comma-shaped bacteria;
no erythrocytes of leukocytes. MOA of toxin? - ANSWER- Activation
of adenylyl cyclase
59yo F with gradual onset of lack of muscle control in her left arm and
leg. Sx 1 mo ago after dx with metastatic breast cancer. PE shows ataxia
of left upper and lower extremities. Muscle strength, DTR, sensation,
proprioception normal. Metastatic tumor in which location? -
ANSWER- cerebellum
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows
petechial rash, microcephaly, and hepatosplenomegaly. Serologic test
for CMV: IgG + in mother, + in newborn; IGM - in mother, + in
newborn. Explanation? - ANSWER- Congenital cytomegalovirus
infection
,Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at
1/5 min. PE shows a bulging, fluod0filled mass approximately 5 cm in
diameter in the midline over the lumbosacral region. No spontaneous
movements of the lower extremities. Abnormality most likely occurred
because of abnormal development during which periods of
postconception (in days)? - ANSWER- 15 to 40
64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has
ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial
fibrillation. Intravenous ibutilide is administered. Ten minutes later,
ECG shows normal sinus rhythm. Risk for which drug effect in the next
6 hours? - ANSWER- torsades de pointes
65yo F with 20-year hx of osteoarthritis of the hands now has pain
radiating down the distal anterior thigh, knee, medial leg, and food.
Bony outgrowth of vertebrae compressing one of the spinal nerves is
suspected. Nerve root in which intervertebral foramina is effected? -
ANSWER- L3 to L4
38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic
agent, he has tried diet and exercise. BMI 32. PE normal. Hb A1c is
10%. Physician recommends initiation of insulin injections. Responds,
"I know that insulin would help control my blood sugar. But a lot of
people in my family have diabetes, and insulin made them really sick at
times. Patient is at which stage of change? - ANSWER- contemplation
24yo M with 2-day history of an itchy rash on his arms and legs.
Returned from a camping trip in the woods 5 days ago. PE shows
edematous, erythematous rash with linear vesicles. Cause is activation of
which cell types? - ANSWER- T lymphocytes
70yo M from china with poorly differentiated monoclonal carcinoma of
the nasopharynx. DNA probes of neoplastic cells are most likely to
detect genome of which virus? - ANSWER- EBV
, Epidemiologic study of aniline dye, 500 workers with bladder cancer
and 200 workers without. Exposed to aniline dyes/Have Bladder cancer:
Yes/Yes (250), Yes/No (50), No/Yes (250), No/No (150). Odds ratio? -
ANSWER- 3
24yo M with hx of IVDA could not be aroused. Friend reports that the
patient injected himself with a drug 6 hours ago. Labs show drug
concentration of 0.3. Assuming first-order one-compartment kinetics,
has a half-life of 2 hours, and a volume of distribution of 200 L in this
patient. What is quantity of drug (in mg) injected? - ANSWER- 480
Compound is taken up by bacterial cells. No energy is necessary for
uptake, and the compound is not concentrated in the cell. Which
describes this mechanism of transport? - ANSWER- carrier-mediated
diffusion
Newborn has male genital ducts but female external genitalia.
Cytogenetic analysis shows a 46,XY karyotype, and genetic testing
shows a mutation of the gene encoding 5alpha-reductase. In absence of
this mutation, labia majora would have been? - ANSWER- scrotum
Study designed to evaluate the efficacy of coenzyme Q10 in improving
cardiac output in patients with CHF. Sixty patients with CHF are
recruited. Each assigned by coin toss to one of two groups. Design? -
ANSWER- randomized clinical trial
12yo boy immersed up to his neck in 60F water for 20 minutes.
Physiological changes? - ANSWER- Central blood volume
INCREASED, ADH (vasopressin) DECREASED, Atrial Natriuretic
Peptide INCREASED? C (block3, q23)
Randomized controlled study of 2000 patients with insomnia is
conducted to evaluate the efficacy of a new medication to treat this
condition. Ten subjects from both the control and treatment groups do
not complete the study are not included in the analysis. Treatment group
QUESTIONS AND ANSWERS LATEST
2023-2024 (usmle step 1)MEDICAL
EXAMINATION
70yo M dies in a motor vehicle collision. Was undergoing evaluation for
occult blood in the stool. Photo of transverse colon shown. Dx? -
ANSWER- Tubular adenoma
38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical
shows inflamed nasal mucosa. No congestion in lower lung.
Pharmacotherapy? - ANSWER- Loratadine
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T
38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR shows
bilateral interstitial infiltrates. Blood spontaenously agglutinates while
awaiting transport to the laboratory. Antibody isotypes causing
agglutination? - ANSWER- IgM
24yo M with small tender blisters on his penis 3 days after unprotected
sex. Photograph shown. Causal agent? - ANSWER- HSV-2
42yo F with 3-year hx of an intermittent facial rash, including the
forehead, eyelids, nose, and cheeks. Rash seems to be getting worse
since she moved from New York to Florida last year. Spicy foods
precipitate a flushing reaction that seems to exacerbate the rash. PE
shows erythema over the nose and cheeks, with scattered telangiectasias
and a few papules. Dx? - ANSWER- Rosacea
,53yo M returned from Africa, has fever, headache, and abdominal
discomfort. Received appropriate vaccinations prior to the trip. T 39.4C.
A wright-stained peripheral smear shown. Dx? - ANSWER- Malaria
68yo F with T2DM and hypertension that has been poorly controlled
despite hydrochlorothiazide treatment. BP 150/96, Labs show serum
glucose concentration of 130 and proteinuria. In addition to current Rx,
which is most appropriate pharmacotherapy? - ANSWER- Lisinopril
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea
after receiving chemotherapy with fluorouracil, leucovorin, and
Irinotecan. prescribed opioid antidiarrheal agent with no CNS effects.
Which med? - ANSWER- Loperamide
35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had
profuse, watery diarrhea for 8 hours despite a lack of oral intake.
Recently returned from a medical relief trip to a remove village in
Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin and
decreased capillary refill. Stool for occult blood is negative; stool is gray
and turbid. Gram stain shows gram-negative, comma-shaped bacteria;
no erythrocytes of leukocytes. MOA of toxin? - ANSWER- Activation
of adenylyl cyclase
59yo F with gradual onset of lack of muscle control in her left arm and
leg. Sx 1 mo ago after dx with metastatic breast cancer. PE shows ataxia
of left upper and lower extremities. Muscle strength, DTR, sensation,
proprioception normal. Metastatic tumor in which location? -
ANSWER- cerebellum
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows
petechial rash, microcephaly, and hepatosplenomegaly. Serologic test
for CMV: IgG + in mother, + in newborn; IGM - in mother, + in
newborn. Explanation? - ANSWER- Congenital cytomegalovirus
infection
,Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at
1/5 min. PE shows a bulging, fluod0filled mass approximately 5 cm in
diameter in the midline over the lumbosacral region. No spontaneous
movements of the lower extremities. Abnormality most likely occurred
because of abnormal development during which periods of
postconception (in days)? - ANSWER- 15 to 40
64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has
ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial
fibrillation. Intravenous ibutilide is administered. Ten minutes later,
ECG shows normal sinus rhythm. Risk for which drug effect in the next
6 hours? - ANSWER- torsades de pointes
65yo F with 20-year hx of osteoarthritis of the hands now has pain
radiating down the distal anterior thigh, knee, medial leg, and food.
Bony outgrowth of vertebrae compressing one of the spinal nerves is
suspected. Nerve root in which intervertebral foramina is effected? -
ANSWER- L3 to L4
38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic
agent, he has tried diet and exercise. BMI 32. PE normal. Hb A1c is
10%. Physician recommends initiation of insulin injections. Responds,
"I know that insulin would help control my blood sugar. But a lot of
people in my family have diabetes, and insulin made them really sick at
times. Patient is at which stage of change? - ANSWER- contemplation
24yo M with 2-day history of an itchy rash on his arms and legs.
Returned from a camping trip in the woods 5 days ago. PE shows
edematous, erythematous rash with linear vesicles. Cause is activation of
which cell types? - ANSWER- T lymphocytes
70yo M from china with poorly differentiated monoclonal carcinoma of
the nasopharynx. DNA probes of neoplastic cells are most likely to
detect genome of which virus? - ANSWER- EBV
, Epidemiologic study of aniline dye, 500 workers with bladder cancer
and 200 workers without. Exposed to aniline dyes/Have Bladder cancer:
Yes/Yes (250), Yes/No (50), No/Yes (250), No/No (150). Odds ratio? -
ANSWER- 3
24yo M with hx of IVDA could not be aroused. Friend reports that the
patient injected himself with a drug 6 hours ago. Labs show drug
concentration of 0.3. Assuming first-order one-compartment kinetics,
has a half-life of 2 hours, and a volume of distribution of 200 L in this
patient. What is quantity of drug (in mg) injected? - ANSWER- 480
Compound is taken up by bacterial cells. No energy is necessary for
uptake, and the compound is not concentrated in the cell. Which
describes this mechanism of transport? - ANSWER- carrier-mediated
diffusion
Newborn has male genital ducts but female external genitalia.
Cytogenetic analysis shows a 46,XY karyotype, and genetic testing
shows a mutation of the gene encoding 5alpha-reductase. In absence of
this mutation, labia majora would have been? - ANSWER- scrotum
Study designed to evaluate the efficacy of coenzyme Q10 in improving
cardiac output in patients with CHF. Sixty patients with CHF are
recruited. Each assigned by coin toss to one of two groups. Design? -
ANSWER- randomized clinical trial
12yo boy immersed up to his neck in 60F water for 20 minutes.
Physiological changes? - ANSWER- Central blood volume
INCREASED, ADH (vasopressin) DECREASED, Atrial Natriuretic
Peptide INCREASED? C (block3, q23)
Randomized controlled study of 2000 patients with insomnia is
conducted to evaluate the efficacy of a new medication to treat this
condition. Ten subjects from both the control and treatment groups do
not complete the study are not included in the analysis. Treatment group
