1|Page
NBME CBSE REAL EXAM 400 QUESTIONS AND
ANSWERS LATEST (usmle step 1)MEDICAL
EXAMINATION
1. 70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult
blood in the stool. Photo of transverse colon shown. Dx?
- Tubular adenoma
2. 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?
- Loratadine
3. 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?
- IgM
4. 24yo M with small tender blisters on his penis 3 days after unprotected sex.
Photograph shown. Causal agent?
- Herpes simplex virus type 2
5. 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?
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- Rosacea
6. 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?
- Malaria
7. 68yo F with T2DM and hypertension that has eben 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?
- Lisinopril
8. 66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after
receiving chemotherapy with flourouracil, leucovorin, and irinotecan. perscribed
opioid antidiarrheal agent with no CNS effects. Which med?
- Loperamide
9. 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?
- Activation of adenylyl cyclase
10. 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
,3|Page
lower extremities. Muscle strength, DTR, sensation, proprioception normal.
Metastatic tumor in which location?
- Cerebellum
11. 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?
- Congenital cytomegalovirus infection
12. 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)?
- 15 to 40
13. 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?
- Torsades de pointes
14. 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?
- L-3 to 4
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15. 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?
- Contemplation
16. 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?
- T lymphocytes
17. 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?
- Epstein-Barr virus
18. 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?
-3
19. 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?
- 480
NBME CBSE REAL EXAM 400 QUESTIONS AND
ANSWERS LATEST (usmle step 1)MEDICAL
EXAMINATION
1. 70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult
blood in the stool. Photo of transverse colon shown. Dx?
- Tubular adenoma
2. 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?
- Loratadine
3. 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?
- IgM
4. 24yo M with small tender blisters on his penis 3 days after unprotected sex.
Photograph shown. Causal agent?
- Herpes simplex virus type 2
5. 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?
,2|Page
- Rosacea
6. 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?
- Malaria
7. 68yo F with T2DM and hypertension that has eben 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?
- Lisinopril
8. 66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after
receiving chemotherapy with flourouracil, leucovorin, and irinotecan. perscribed
opioid antidiarrheal agent with no CNS effects. Which med?
- Loperamide
9. 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?
- Activation of adenylyl cyclase
10. 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
,3|Page
lower extremities. Muscle strength, DTR, sensation, proprioception normal.
Metastatic tumor in which location?
- Cerebellum
11. 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?
- Congenital cytomegalovirus infection
12. 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)?
- 15 to 40
13. 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?
- Torsades de pointes
14. 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?
- L-3 to 4
, 4|Page
15. 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?
- Contemplation
16. 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?
- T lymphocytes
17. 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?
- Epstein-Barr virus
18. 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?
-3
19. 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?
- 480
