NBME 17 NBME CBSE NEWEST VERSION EXAM
QUESTIONS & ANSWERS WITH GUARANTEED PASS
70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult blood in the
stool. Photo of transverse colon shown. Dx? - CORRECT ANSWER >>>Tubular adenoma or
villous polyp. GI blood loss suggests a risk for malignancy
38yo M truck driver with 1-week hx of watery, itchy eyes and a runny nose. Physical shows
inflamed nasal mucosa. No congestion in lower lung. Pharmacotherapy? - CORRECT ANSWER
>>>Loratadine--> less sedating antihistamine
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? - CORRECT ANSWER >>>IgM (mono and mycoplasma)
24yo M with small tender blisters on his penis 3 days after unprotected sex. Photograph shown.
Causal agent? - CORRECT 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? -
CORRECT 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
(ring forms in RBCs). Dx? - CORRECT ANSWER >>>Malaria
68yo F with T2DM and hypertension that has been poorly controlled despite
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,hydrochlorothiazide treatment. BP 150/96, Labs show serum glucose concentration of 130 and
proteinuria. In addition to current Rx, which is most appropriate pharmacotherapy? - CORRECT
ANSWER >>>ACE I (Lisinopril)
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving
chemotherapy with flourouracil, leucovorin, and irinotecan. Prescribed opioid antidiarrheal
agent with no CNS effects. Which med? - CORRECT 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 gramnegative,
comma-shaped bacteria; no erythrocytes of leukocytes. MOA of toxin? - CORRECT ANSWER
>>>V. Cholerae--> activates AC
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? -
CORRECT 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? - CORRECT ANSWER >>>Congenital CMV 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)? -
CORRECT ANSWER >>>15-40; neutral tube closes at about 4 weeks
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
2|Page
,minutes later, ECG shows normal sinus rhythm. Risk for which drug effect in the next 6 hours? -
CORRECT 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? - CORRECT
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? - CORRECT 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? - CORRECT ANSWER >>>T-lymphocytes (type IV HS)
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? - CORRECT
ANSWER >>>EBV
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
onecompartment 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? - CORRECT ANSWER >>>= 200 (0.3) =60
3 half-lives = 120, 240, 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? - CORRECT
ANSWER >>>Carrier-mediated diffusion
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, 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? - CORRECT ANSWER >>>Scrotum
Corresponded to penis shaft? - CORRECT ANSWER >>>Labia minora
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 tw
groups. Design? - CORRECT ANSWER >>>RCT
12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological changes?
ADH:
Central Blood volume:
ANP: - CORRECT ANSWER >>>ADH: decreased (VC leads to decreased ADH)
ANP: increased
Central blood volume: increased
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 are not included in the analysis. Treatment
group able to fall asleep 5 minutes faster than control (p=0.001). Neither group report an
improvement in quality of life. Conclude that new med is efficacious in treating insomnia. Type
of error? - CORRECT ANSWER >>>Failure to distinguish between statistical significant and
clinical significance
50yo M with increasing cough for 6 month and hemoptysis for 1 week. Smoked 1 pack per day
for 32 years. Plays squash, swims. CXR shows a 3 x 4-cm hilar mass. Cytologic examination of
sputum shows a non-small cell carcinoma. Tells patient he has lung cancer. The patient
responds, "How can this be happening to m? I eat right and exercise." Appropriate response? -
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QUESTIONS & ANSWERS WITH GUARANTEED PASS
70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult blood in the
stool. Photo of transverse colon shown. Dx? - CORRECT ANSWER >>>Tubular adenoma or
villous polyp. GI blood loss suggests a risk for malignancy
38yo M truck driver with 1-week hx of watery, itchy eyes and a runny nose. Physical shows
inflamed nasal mucosa. No congestion in lower lung. Pharmacotherapy? - CORRECT ANSWER
>>>Loratadine--> less sedating antihistamine
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? - CORRECT ANSWER >>>IgM (mono and mycoplasma)
24yo M with small tender blisters on his penis 3 days after unprotected sex. Photograph shown.
Causal agent? - CORRECT 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? -
CORRECT 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
(ring forms in RBCs). Dx? - CORRECT ANSWER >>>Malaria
68yo F with T2DM and hypertension that has been poorly controlled despite
1|Page
,hydrochlorothiazide treatment. BP 150/96, Labs show serum glucose concentration of 130 and
proteinuria. In addition to current Rx, which is most appropriate pharmacotherapy? - CORRECT
ANSWER >>>ACE I (Lisinopril)
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving
chemotherapy with flourouracil, leucovorin, and irinotecan. Prescribed opioid antidiarrheal
agent with no CNS effects. Which med? - CORRECT 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 gramnegative,
comma-shaped bacteria; no erythrocytes of leukocytes. MOA of toxin? - CORRECT ANSWER
>>>V. Cholerae--> activates AC
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? -
CORRECT 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? - CORRECT ANSWER >>>Congenital CMV 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)? -
CORRECT ANSWER >>>15-40; neutral tube closes at about 4 weeks
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
2|Page
,minutes later, ECG shows normal sinus rhythm. Risk for which drug effect in the next 6 hours? -
CORRECT 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? - CORRECT
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? - CORRECT 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? - CORRECT ANSWER >>>T-lymphocytes (type IV HS)
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? - CORRECT
ANSWER >>>EBV
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
onecompartment 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? - CORRECT ANSWER >>>= 200 (0.3) =60
3 half-lives = 120, 240, 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? - CORRECT
ANSWER >>>Carrier-mediated diffusion
3|Page
, 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? - CORRECT ANSWER >>>Scrotum
Corresponded to penis shaft? - CORRECT ANSWER >>>Labia minora
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 tw
groups. Design? - CORRECT ANSWER >>>RCT
12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological changes?
ADH:
Central Blood volume:
ANP: - CORRECT ANSWER >>>ADH: decreased (VC leads to decreased ADH)
ANP: increased
Central blood volume: increased
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 are not included in the analysis. Treatment
group able to fall asleep 5 minutes faster than control (p=0.001). Neither group report an
improvement in quality of life. Conclude that new med is efficacious in treating insomnia. Type
of error? - CORRECT ANSWER >>>Failure to distinguish between statistical significant and
clinical significance
50yo M with increasing cough for 6 month and hemoptysis for 1 week. Smoked 1 pack per day
for 32 years. Plays squash, swims. CXR shows a 3 x 4-cm hilar mass. Cytologic examination of
sputum shows a non-small cell carcinoma. Tells patient he has lung cancer. The patient
responds, "How can this be happening to m? I eat right and exercise." Appropriate response? -
4|Page
