NBME - 13, 15, 16 Exam Questions and Answers 2023
60 yo M w/weakness and lt headed for 3 mo. Diet consists of fruit, veg, grains, fish, chicken. Has Hashimoto's. On thyroxine. PE shows pallor. Serum studies show inc'd methylmalonic acid and homocysteine. PBS shows megaloblastic anemia. Dx? - Answer- Dx: B12 deficiency
Note: Both homocystinuria and B12 deficiency have homocystinemia but B13 also has methylomalonic acidemia and macrocytic anemia
Which region of the bone is responsible for making new bone? - Answer- Periosteum - outer layer. this is where the osteoblasts are
6 yo F w/severe abd pain, nausea, vomiting 4hr after eating cake and pastries. Dx? Bacteremia or preformed toxin? - Answer- Dx: Staphylococcus aureus food poisoning
Pre-formed enterotoxin
54 yo F w/5d hx of severe back pain. Presents w/hypercalcemia, Bence Jones proteins. Cause of hypercalcemia? - Answer- Dx: Multiple myeloma
Hypercalcemia: IL1 and TNF secretion affects bone osteoclasts
27 yo F w/2 y hx of episodic dbl vision, intermittent numbness and tingling in arms, urinary incontinence, dysarthria. MRI shows few sm, scattered nonspecific wt matter plaques. Dx? - Answer- Dx: Multiple sclerosis
64 yo F w/6mo hx of heartburn and solid and liquid dysphagia. 2y hx of pain and swelling of wrists and hands. PE shows no wrinkles on hands or face. Synovial thickening of wrists bilaterally. Dx? Effect on esophageal peristalsis and LES tone? - Answer- Dx: Scleroderma
LES tone: dec'd bc sphincter replaced w/fibrosis
Esoph peristalsis: dec'd d/t fibrosis
18 yo F w/mild mental retardation brought in bc difficulty seeing. Lifelong hx of chronic diarrhea. 2 y ago devel'd lack of musc control in arms and legs, weakness. 16yo brother
w/same sx. PE shows bilat retinitis pigmentosa, ataxia, loss of DTRs. PBS shows erythrocytes w/spiny projections. Serum total chol = 40 mg/dL. Which apolipoprotein deficient? Dx? - Answer- Dx: Abetalipoproteinemia Deficient: Apo B - Both ApoB-48 and ApoB-100
23 yo F w/DM1. 2y hx of recurrent yeast infects. Has genetic deficiency where can't make hydroxyhalide. What enzyme is deficient? - Answer- Dx: Myeloperoxidase deficiency
MOA: Makes HClO radical
29 yo F w/depressed mood, LOA, difficulty sleeping, feelings of guilt, loss of energy for 3 years. There was a brief 1 month break where she felt normal. Dx? - Answer- Dx: Dysthymia aka Persistent depressive disorder
3 yo F w/1y hx of short stature. PE shows coarse facial features, dysostosis multiplex, contractures of large joints. Plasma lysosomal enz analysis shows inc'd beta-
hexosaminidase, beta-glucuronidase, beta-galactosidase and alpha-fucosidase. Dx? - Answer- Dx: I cell disease
MOA: Failure of golgi to phos mannose on glycoprots so prots secreted extracellularly instead of delivered to lysosomes
56 yo M w/biliary tract infection. Had pigmented gallstones removed. Works at sushi restaurant. Which trematode could have caused this. - Answer- Clonorchis sinensis
43 yo M w/10y hx of alcoholism presents w/jaundice. Has taxen 2 extra strength acetaminophen every 4-6 hrs for past 3d for severe HA. Inc'd PT and AST. What metabolite will be decreased that causes this condition? - Answer- Dec'd glutathione bc depleted by acetaminophen NAPQI metabolism --> hemolysis like in G6PD deficiency --
> jaundice
47 yo M w/MI. Crackles at lung base, dec in O2 sat, grade 2/6 systolic murmur. ABG shows pH 7.41, PCO2 36 mmHg, PO2 60 mmHg. What is the cause of his hypoxemia? - Answer- Pt had an MI and now has some valvular dysfxn causing b to back up into lungs --> inc'd pulm cap P --> O2 rich b is backed up --> tissue hypoxia and hypoxemia
25 yo F w/hx of rheumatic fever and mitral valve dysfxn has 2wk hx of fever and fatigue.
Had root canal 1 mo ago and took 1 dose amoxicillin before proc. Investigations show alpha hemolytic cocci in chains. Dx? Sp? - Answer- Dx: Infective endocarditis
Sp: Streptococcus mitis
35 yo F w/2mo hx of generalized weakness and fatigability that is exacerbated w/exercise. Sx onset during preg. PE shows diplopia, reduction in arm musc strength w/repetitive mvmt, preservation of DTRs. Oralpyridostigmine improves sx. Dx? Autoabs? - Answer- Dx: Myasthenia gravis
Abs: Anti-nicotinic Ach R
60 yo M w/weakness and lt headed for 3 mo. Diet consists of fruit, veg, grains, fish, chicken. Has Hashimoto's. On thyroxine. PE shows pallor. Serum studies show inc'd methylmalonic acid and homocysteine. PBS shows megaloblastic anemia. Dx? - Answer- Dx: B12 deficiency
Note: Both homocystinuria and B12 deficiency have homocystinemia but B13 also has methylomalonic acidemia and macrocytic anemia
Which region of the bone is responsible for making new bone? - Answer- Periosteum - outer layer. this is where the osteoblasts are
6 yo F w/severe abd pain, nausea, vomiting 4hr after eating cake and pastries. Dx? Bacteremia or preformed toxin? - Answer- Dx: Staphylococcus aureus food poisoning
Pre-formed enterotoxin
54 yo F w/5d hx of severe back pain. Presents w/hypercalcemia, Bence Jones proteins. Cause of hypercalcemia? - Answer- Dx: Multiple myeloma
Hypercalcemia: IL1 and TNF secretion affects bone osteoclasts
27 yo F w/2 y hx of episodic dbl vision, intermittent numbness and tingling in arms, urinary incontinence, dysarthria. MRI shows few sm, scattered nonspecific wt matter plaques. Dx? - Answer- Dx: Multiple sclerosis
64 yo F w/6mo hx of heartburn and solid and liquid dysphagia. 2y hx of pain and swelling of wrists and hands. PE shows no wrinkles on hands or face. Synovial thickening of wrists bilaterally. Dx? Effect on esophageal peristalsis and LES tone? - Answer- Dx: Scleroderma
LES tone: dec'd bc sphincter replaced w/fibrosis
Esoph peristalsis: dec'd d/t fibrosis
18 yo F w/mild mental retardation brought in bc difficulty seeing. Lifelong hx of chronic diarrhea. 2 y ago devel'd lack of musc control in arms and legs, weakness. 16yo brother
w/same sx. PE shows bilat retinitis pigmentosa, ataxia, loss of DTRs. PBS shows erythrocytes w/spiny projections. Serum total chol = 40 mg/dL. Which apolipoprotein deficient? Dx? - Answer- Dx: Abetalipoproteinemia Deficient: Apo B - Both ApoB-48 and ApoB-100
23 yo F w/DM1. 2y hx of recurrent yeast infects. Has genetic deficiency where can't make hydroxyhalide. What enzyme is deficient? - Answer- Dx: Myeloperoxidase deficiency
MOA: Makes HClO radical
29 yo F w/depressed mood, LOA, difficulty sleeping, feelings of guilt, loss of energy for 3 years. There was a brief 1 month break where she felt normal. Dx? - Answer- Dx: Dysthymia aka Persistent depressive disorder
3 yo F w/1y hx of short stature. PE shows coarse facial features, dysostosis multiplex, contractures of large joints. Plasma lysosomal enz analysis shows inc'd beta-
hexosaminidase, beta-glucuronidase, beta-galactosidase and alpha-fucosidase. Dx? - Answer- Dx: I cell disease
MOA: Failure of golgi to phos mannose on glycoprots so prots secreted extracellularly instead of delivered to lysosomes
56 yo M w/biliary tract infection. Had pigmented gallstones removed. Works at sushi restaurant. Which trematode could have caused this. - Answer- Clonorchis sinensis
43 yo M w/10y hx of alcoholism presents w/jaundice. Has taxen 2 extra strength acetaminophen every 4-6 hrs for past 3d for severe HA. Inc'd PT and AST. What metabolite will be decreased that causes this condition? - Answer- Dec'd glutathione bc depleted by acetaminophen NAPQI metabolism --> hemolysis like in G6PD deficiency --
> jaundice
47 yo M w/MI. Crackles at lung base, dec in O2 sat, grade 2/6 systolic murmur. ABG shows pH 7.41, PCO2 36 mmHg, PO2 60 mmHg. What is the cause of his hypoxemia? - Answer- Pt had an MI and now has some valvular dysfxn causing b to back up into lungs --> inc'd pulm cap P --> O2 rich b is backed up --> tissue hypoxia and hypoxemia
25 yo F w/hx of rheumatic fever and mitral valve dysfxn has 2wk hx of fever and fatigue.
Had root canal 1 mo ago and took 1 dose amoxicillin before proc. Investigations show alpha hemolytic cocci in chains. Dx? Sp? - Answer- Dx: Infective endocarditis
Sp: Streptococcus mitis
35 yo F w/2mo hx of generalized weakness and fatigability that is exacerbated w/exercise. Sx onset during preg. PE shows diplopia, reduction in arm musc strength w/repetitive mvmt, preservation of DTRs. Oralpyridostigmine improves sx. Dx? Autoabs? - Answer- Dx: Myasthenia gravis
Abs: Anti-nicotinic Ach R
