NBME CBSE REAL EXAM
2023-2024 (USMLE step 1) MEDICAL EXAMINATION
70-year-old male dies in a motor vehicle collision. Was undergoing evaluation
for occult blood in the stool. Photo of transverse colon shown. Diagnosis is?
ANSWER- Tubular adenoma
38-year-old male with 1-week history of watery, itchy eyes and a runny nose.
Physical shows inflamed nasal mucosa. No congestion in lower lung.
Pharmacotherapy?
ANSWER- Loratadine
16-year-old girl with 3-day history of fever, nonproductive cough, and
fatigue. T 38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. Chest X-
ray shows bilateral interstitial infiltrates. Blood spontaneously agglutinates
while awaiting transport to the laboratory. Antibody isotypes causing
agglutination?
ANSWER- IgM
24-year-old male with small tender blisters on his penis 3 days after
unprotected sex. Photograph shown. Causal agent?
ANSWER- HSV-2
42-year-old female with 3-year history 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. Diagnosis?
ANSWER- Rosacea
,35-year-old male in ED with 2-hour history 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.
53-year-old male 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. Diagnosis?
ANSWER- Malaria
68-year-old female 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
treatment, which is most appropriate pharmacotherapy?
ANSWER- Lisinopril
66-year-old male with stage IV colon cancer with 3-day history of severe
diarrhea after receiving chemotherapy with fluorouracil, leucovorin, and
Irinotecan. prescribed opioid antidiarrheal agent with no CNS effects. Which
med?
ANSWER- Loperamide
59-year-old female with gradual onset of lack of muscle control in her left
arm and leg. Sx 1 month ago after diagnosis 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, fluid filled 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 post-conception (in days)?
ANSWER- 15 to 40
64-year-old male 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
65-year-old female with 20-year history 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
38-year-old male with 3-year history 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
, 24-year-old male 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
70-year-old male 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
24-year-old male with history 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 karyo type, and genetic testing shows a mutation of
the gene encoding 5-alpha-reductase. In absence of this mutation, labia
majora would have been?
2023-2024 (USMLE step 1) MEDICAL EXAMINATION
70-year-old male dies in a motor vehicle collision. Was undergoing evaluation
for occult blood in the stool. Photo of transverse colon shown. Diagnosis is?
ANSWER- Tubular adenoma
38-year-old male with 1-week history of watery, itchy eyes and a runny nose.
Physical shows inflamed nasal mucosa. No congestion in lower lung.
Pharmacotherapy?
ANSWER- Loratadine
16-year-old girl with 3-day history of fever, nonproductive cough, and
fatigue. T 38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. Chest X-
ray shows bilateral interstitial infiltrates. Blood spontaneously agglutinates
while awaiting transport to the laboratory. Antibody isotypes causing
agglutination?
ANSWER- IgM
24-year-old male with small tender blisters on his penis 3 days after
unprotected sex. Photograph shown. Causal agent?
ANSWER- HSV-2
42-year-old female with 3-year history 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. Diagnosis?
ANSWER- Rosacea
,35-year-old male in ED with 2-hour history 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.
53-year-old male 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. Diagnosis?
ANSWER- Malaria
68-year-old female 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
treatment, which is most appropriate pharmacotherapy?
ANSWER- Lisinopril
66-year-old male with stage IV colon cancer with 3-day history of severe
diarrhea after receiving chemotherapy with fluorouracil, leucovorin, and
Irinotecan. prescribed opioid antidiarrheal agent with no CNS effects. Which
med?
ANSWER- Loperamide
59-year-old female with gradual onset of lack of muscle control in her left
arm and leg. Sx 1 month ago after diagnosis 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, fluid filled 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 post-conception (in days)?
ANSWER- 15 to 40
64-year-old male 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
65-year-old female with 20-year history 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
38-year-old male with 3-year history 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
, 24-year-old male 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
70-year-old male 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
24-year-old male with history 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 karyo type, and genetic testing shows a mutation of
the gene encoding 5-alpha-reductase. In absence of this mutation, labia
majora would have been?
