NBME 19 2024 EXAM
QUESTIONS AND REVIEWED
CORRECT ANSWERS
23yo women strenuous exercise. X-sectional area of pulmonary
microcirculation? - ANSWER increased, as a result of distention
and recruitment of microvessels
33yo woman had weakness of right lower 2/3 of face. Where is
brain lesion? - ANSWER Primary motor cortex
30 yo man and 24 yo woman genetic counseling. Man's brother
has type 1 oculocutaneous albinism (AR). Single gene disorder
1/40,000 in population. Pedigree shown. What are the odds? -
ANSWER q= sqr. rt of 1/40000 = 1/200
pq= 1/= 1/100
1/100 that mom is a heterozygote
2/3 that dad is a carrier
AR disease= 1/4 of offspring affected
(1/100) (2/3) (1/4)= 1/600
Chemical disrupts tight junction between cells in the testes.
Autoimmune response to products of germ cells entered
circulation. What cells disrupted? - ANSWER Sertoli cells
,76 yo man 30mins severe substernal chest pain while arguing
with brother. 3 sublingal nitroglycerin no relieve. 5y h/o ischemic
heart disease. P110, R20, BP120/80. Cardiac exam normal. EKG
ST elevation at leads I, aVl, and V4-V9. What happened during
argument with brother? - ANSWER Coronary vasospasm due to
alpha 1 stimulation
40yo G0 women delivered newborn. CVS at 15 wks results male
chromosome fetus. Physical exam show female external genitals
and absent internal genitals. Mutation prevent response to what?
- ANSWER Testosterone
13yo girl grew 3in over summer. What accounts for increased Ca
absorption? - ANSWER Hormones derived from 7-
dehyrocholesterol
56 yo man lethargy. No meds, no postural hypotention, no
edema. Na: 125. Others normal. Dx? - ANSWER Small Cell
Carcinoma of lungs
15 yo girl received BMT 1 year ago due to AML. Now karyotype
46, XY. Dx? - ANSWER Nonautologous donor
25 yo woman w/ AIDS in ICU treated for sepsis by Cryptococcus
neoformans. Drug? - ANSWER Amphotericin B
27yo man 4 days of cough producing blood-tinged sputum.
BP160/100. Creatine: 4.8, erthyrocyte casts in urine. IgG
deposites in IF microscopy. What glomerulus histologic
abnormalities? - ANSWER Crescent formation
48yo man. 3 yrs ago removed right kidney and adrenal gland of
encapsulated renal cell carcinoma. 2 annual exams normal. No
,EtOH and no smoking. P75, BP130/88. Physical exam normal.
Serum mild increased bilirubin, ALT, AST and ALP. CT abdomen
shows widening hepatic venules. Radiographic fluorography
pressure: R Atria: 5, Hepatic vein: 25, Hepatic wedge: 30. Dx? -
ANSWER Budd-Chiari Syndrome
48 yo man in hospital for idiopathic pulmonary hypertension. 6
months progressive dyspnea. Cadiac catheterization show
decreased in cardiac function. Whats increased? - ANSWER RV
afterload
Growing polypeptide is in P position. What is next? - ANSWER
binding of aminoacyl-tRNA to the A site.
65 yo man low back pain. Multiple osteoblastic lesions in
vertebrae on x ray. Whats increased in serum? - ANSWER PSA
43 yo man severe hip pain after fall. 15y h/o RA. Fracture and
marked osteopenia of hip on xray. What drug responsible? -
ANSWER Prednisone
35 yo man w/ HIV. 2 yrs of HAART. Physical exam thin
extremeties, wide abdominal girth, and buffalo hump on upper
back. Labs: CD4: 43, viral load: 1190, glucose: 110, cholesterol:
225, Triglycerides: 260. Glucose tolerance test is abnormal.
Cause? - ANSWER Protease inhibitor
80 yo woman SOB and fatigue. Dx severe aortic stenosis.
Undergoes AV replacement. After operation, dicumarol is given,
result in prolonged PT. Cause? - ANSWER Induces a vitamin K
deficiency state
23 yo woman DVT at 6 months pregnant. IV heparin started. 7
days later platelet count: 44,000. Dx? - ANSWER Antiplatelet
antibodies
, 52 yo man 30mins of substernal chest pain. Pain persisted even
w/ 3 doses of sublingual nitroglycerin. P90, BP114/70.
Diaphoresis. Lungs clear. S4, ST elevation in inferior leads. IV
morphine started. 1 min later develops generalized pruritus. P120,
BP90/50. Physical exam facial flushing. What substance cause
new symptoms? - ANSWER Histamine
19 yo man stabbed in abdomen. Denies starting fight and intends
to "get even". Incarcerated for past 3 yrs for armed robbery but
says he was "set up". Dx? - ANSWER Antisocial personality
disorder
45 yo man major depressive disorder. Taking Fluoxetine.
Increased risk of serotonin syndrome w/ what in food? - ANSWER
Tryptophan
40yo man increased malaise, nausea, abdominal pain and light
colored stools. Tenderness to RUQ. Bilirubin:4, ALP: 180, AST:
1500, ALT: 1700. HBeAg, HBsAg, HBV-DNA, IgM anti-HBc
antigen: positive. Further observation shows CD8 T cells bind to
antigens resulting in liver injury. Where's antigen from? -
ANSWER Hepatocytes
52 yo man severe headache, anxiety, sweating and palpitations.
Well controlled HTN w/ clonidine and HCTZ, but ran out of Rx 3
days ago. P120, BP170/110, Physical exam diaphoresis. What
happens after injection of propranolol? - ANSWER Decreased CO
and increased TPR
B-agonists act to increase CO and vasodilate SM
ABG values in a resting patient.
QUESTIONS AND REVIEWED
CORRECT ANSWERS
23yo women strenuous exercise. X-sectional area of pulmonary
microcirculation? - ANSWER increased, as a result of distention
and recruitment of microvessels
33yo woman had weakness of right lower 2/3 of face. Where is
brain lesion? - ANSWER Primary motor cortex
30 yo man and 24 yo woman genetic counseling. Man's brother
has type 1 oculocutaneous albinism (AR). Single gene disorder
1/40,000 in population. Pedigree shown. What are the odds? -
ANSWER q= sqr. rt of 1/40000 = 1/200
pq= 1/= 1/100
1/100 that mom is a heterozygote
2/3 that dad is a carrier
AR disease= 1/4 of offspring affected
(1/100) (2/3) (1/4)= 1/600
Chemical disrupts tight junction between cells in the testes.
Autoimmune response to products of germ cells entered
circulation. What cells disrupted? - ANSWER Sertoli cells
,76 yo man 30mins severe substernal chest pain while arguing
with brother. 3 sublingal nitroglycerin no relieve. 5y h/o ischemic
heart disease. P110, R20, BP120/80. Cardiac exam normal. EKG
ST elevation at leads I, aVl, and V4-V9. What happened during
argument with brother? - ANSWER Coronary vasospasm due to
alpha 1 stimulation
40yo G0 women delivered newborn. CVS at 15 wks results male
chromosome fetus. Physical exam show female external genitals
and absent internal genitals. Mutation prevent response to what?
- ANSWER Testosterone
13yo girl grew 3in over summer. What accounts for increased Ca
absorption? - ANSWER Hormones derived from 7-
dehyrocholesterol
56 yo man lethargy. No meds, no postural hypotention, no
edema. Na: 125. Others normal. Dx? - ANSWER Small Cell
Carcinoma of lungs
15 yo girl received BMT 1 year ago due to AML. Now karyotype
46, XY. Dx? - ANSWER Nonautologous donor
25 yo woman w/ AIDS in ICU treated for sepsis by Cryptococcus
neoformans. Drug? - ANSWER Amphotericin B
27yo man 4 days of cough producing blood-tinged sputum.
BP160/100. Creatine: 4.8, erthyrocyte casts in urine. IgG
deposites in IF microscopy. What glomerulus histologic
abnormalities? - ANSWER Crescent formation
48yo man. 3 yrs ago removed right kidney and adrenal gland of
encapsulated renal cell carcinoma. 2 annual exams normal. No
,EtOH and no smoking. P75, BP130/88. Physical exam normal.
Serum mild increased bilirubin, ALT, AST and ALP. CT abdomen
shows widening hepatic venules. Radiographic fluorography
pressure: R Atria: 5, Hepatic vein: 25, Hepatic wedge: 30. Dx? -
ANSWER Budd-Chiari Syndrome
48 yo man in hospital for idiopathic pulmonary hypertension. 6
months progressive dyspnea. Cadiac catheterization show
decreased in cardiac function. Whats increased? - ANSWER RV
afterload
Growing polypeptide is in P position. What is next? - ANSWER
binding of aminoacyl-tRNA to the A site.
65 yo man low back pain. Multiple osteoblastic lesions in
vertebrae on x ray. Whats increased in serum? - ANSWER PSA
43 yo man severe hip pain after fall. 15y h/o RA. Fracture and
marked osteopenia of hip on xray. What drug responsible? -
ANSWER Prednisone
35 yo man w/ HIV. 2 yrs of HAART. Physical exam thin
extremeties, wide abdominal girth, and buffalo hump on upper
back. Labs: CD4: 43, viral load: 1190, glucose: 110, cholesterol:
225, Triglycerides: 260. Glucose tolerance test is abnormal.
Cause? - ANSWER Protease inhibitor
80 yo woman SOB and fatigue. Dx severe aortic stenosis.
Undergoes AV replacement. After operation, dicumarol is given,
result in prolonged PT. Cause? - ANSWER Induces a vitamin K
deficiency state
23 yo woman DVT at 6 months pregnant. IV heparin started. 7
days later platelet count: 44,000. Dx? - ANSWER Antiplatelet
antibodies
, 52 yo man 30mins of substernal chest pain. Pain persisted even
w/ 3 doses of sublingual nitroglycerin. P90, BP114/70.
Diaphoresis. Lungs clear. S4, ST elevation in inferior leads. IV
morphine started. 1 min later develops generalized pruritus. P120,
BP90/50. Physical exam facial flushing. What substance cause
new symptoms? - ANSWER Histamine
19 yo man stabbed in abdomen. Denies starting fight and intends
to "get even". Incarcerated for past 3 yrs for armed robbery but
says he was "set up". Dx? - ANSWER Antisocial personality
disorder
45 yo man major depressive disorder. Taking Fluoxetine.
Increased risk of serotonin syndrome w/ what in food? - ANSWER
Tryptophan
40yo man increased malaise, nausea, abdominal pain and light
colored stools. Tenderness to RUQ. Bilirubin:4, ALP: 180, AST:
1500, ALT: 1700. HBeAg, HBsAg, HBV-DNA, IgM anti-HBc
antigen: positive. Further observation shows CD8 T cells bind to
antigens resulting in liver injury. Where's antigen from? -
ANSWER Hepatocytes
52 yo man severe headache, anxiety, sweating and palpitations.
Well controlled HTN w/ clonidine and HCTZ, but ran out of Rx 3
days ago. P120, BP170/110, Physical exam diaphoresis. What
happens after injection of propranolol? - ANSWER Decreased CO
and increased TPR
B-agonists act to increase CO and vasodilate SM
ABG values in a resting patient.
