NBME CBSE TEST QUESTIONS AND VERIFIED ANSWERS - Graded A+

65 year old - TX for metastic breast cancer unresponsive to chemo - never married and has no children. Throughout her illness, another woman - introduced as "my close fiend" has been with her during hospitalization. Pt is moved to inpatient hospice - sign states only family members - Her fiends states "we can't bear to be apart. It would be cruel to separate us now". Response from physician? - The two of you seem to have a very important relationship. Of course you may stay together 62 year old - early Alzheimer's - retired and lives with husbsnd - what is the mostly likely way to help patient maintain her present functional level? - instruct the patient to keep notes and lists to help her memory 40-year-old women - Streptococcus pneumonia - which of the following is produced by the cell is responsible for the restitution of normal lung function? - Surfactant 55 y/o man - 2 month history of fatigue and a 3 day history of nausea and diarrhea - 5.4 kg weight loss Physical exam shows dry skin with hyperpigmentation and delayed cap refill. Lab show Na+ low. Which serum hormone decreased in patient? - Cortisol. A study to assess normal mean serum urea nitrogen in mean ages of 65 years. Which measurement will give precise but inaccurate estimate of mean serum urea nitrogen in this group? - 500 Men from a list of patients scheduled to be examined by the urologist 4 moth baby -rare autosomal recessive skeletal dysplasia involving endochondral bone. Genetic analysis shows null mutations in gene for a protein that controls traffic of vesicles into golgi complex. Which is the most likely show on findings? - dilated Rough Endoplasmic Reticulum 64 year - cough, dyspnea, chest pain - x-ray - shows density in hilar region- biopsy shows small round cells with little cytoplasm arranged in infiltrating sheets that have neither glandular nor squamous organizations. - Which of the following abnormalities in serum? a. Hyponatremia - Hyponatremia Pt with 2 month history of foul smelling, watery diarrhea, flatulence - 10lb weight loss - after trip top Indonesia - no access to clean water -Photomicrograph of stool specimenwhat is MOA of drug - Formation of Destructive Free Radicals Metronidazole - MOA Formation of Destructive Free Radicals 80-year-old woman cannot concentrate urine above 450 mOsmol/kg - she accumulates 450 mOsmol/day - She loses 900 mL of water and 100 in sweat and feces - minimum volume of water to prevent increase in plasma osmolality? - 2.0 1 L losses from kidney + 900 mL insensible + 100 mL in sweat and feces = 2L losses - need to ingest 2 L of water to replace. 75-year-old man dementia, Alzheimer type in nursing facility - wife and children visit weekly -trouble eating - in speaking with patients family- most appropriate for physician to address issues of feeding tube in which manners? - encourage the family to come to a consensus based on their perception of the patient's wishes 20-year-old woman 12 weeks gestation - genetic counseling - she has a reapir for cleft lip, other members of family have cleft lip- which is mostly mode of inheritance of this disorder? - Multifactorial Only abnormality = Cleft lip 24-year-old - history of drug abuse has nausea, rhinorrhea, hypertension, and tachycardia - The most likely cause is withdrawal from which of the following agents? - Heroin 35 y/o veterinarian - headache, cough, fatigue, and myalgia - after delivery of lamb - Temp 102F - Leukocyte count is 12K - X ray shows patchy infiltrates - gram stain of blood and sputum are negative for pathogens. After 2 days started on doxycycline and symptoms alleviate- Which is causal organism? - Coxiella Burnetti 3-day old female newborn - 4 hour history of yellowing of eyes. Jaunice and mildly increased total bilirubin (14.5 n 12). New born placed on phototherapy - Which describes mechanism? - Increased conversion of bilirubin to water soluble isomers Phototherapy = bilirubin is converted to water soluble isomers that are then able to be excreted by the kidney. 2 week male - yellow skin for 7 days - mother is obese - Newborn severely lethargic and hypoglycemic - fed with soybean formula until 4 days ago. He has been breast fed-since then. PE shows jaundice. No glucosuria - Increased serum direct bilirubin concentration- - Galactose - 1-phosphate uridyltransferase 17-year-old T1DM - multiple admissions to hospital during past 5 months for DKA - Appears well She tells the physician that she does not take her insulin regularly - forgets or too busy. Which is most appropriate initial step? - Acknowledge patient reason for missing insulin 1. acknowledge resistance to change 2. address discrepancies between behavior and long-term goals 3. enhance motivation to change 4. nonjudgmental A 48-year-old - complete loss of hearing in his right ear. Which CN on the photograph of ventral surface of brain stem is most likely damaged? - C - right vestibulocochlear nerve - ipsilateral Loss of hearing in right ear = right vestibulocochlear nerve - ipsilateral Feeling and hearing loss Start at the pontomedullary junction and count from superior to inferiorly (or medially to laterally): VI, VII, VIII, IX.