NBME CBSE REAL EXAM 200
QUESTIONS AND ANSWERS LATEST
2023-2024 (usmle step 1)MEDICAL
EXAMINATION LATEST UPDATES MAY 2023 A GRADE.
6yo boy from Russia with unstable gait and incoordination for 2 weeks. Pale, bulky stools for 4 years
and two episodes of bacterial pneumonia and chronic cough since age 1 year. 3%ile for height/weight.
Neuro exam shows ataxia, no DTRs, loss of proprioception. Stool shows inc fat
concentration. Vitamin deficient? - ANSWER- Vitamin E
54yo F 1 week after sudden loss of vision in left eye, returned within 1
day. 3-month hx of progressive SOB with exertion. Echocardiography
shows mass in the left atrium of the heart. Lesion is resected,
photomicrograph of it is shown. Which describes the lesion? -
ANSWER- myxoma
27yo primigravid woman at 34 weeks' with nausea and vomiting, and abdominal pain for 12 hours.
Everything's been normal. BP is now 164/102, and right upper quadrant tenderness. Labs show Hb
7.4, HCT 24%, Platelets 72k, Cr 1.2, total bili 2.3, AST 112, ALT 126. Peripheral blood smear will show? -
ANSWER- Schistocytes
60yo F 3 hours after sudden onset ankle pain. 4-year Hx of increasing serum creatinine concentrations.
Began furosemide 1 month ago, also takes glipizide. P 120/min, resp 25/min, BP 150/100. Joint fluid
shows negatively birefringent crystals. Increased risk of which complications of underlying process
causing joint findings? - ANSWER- Nephrolithiasis
56yo F follow-up 8 weeks after recovering from pneumococcal
pneumonia. Chest X-rays normal. Which allowed this resolution to occur? - ANSWER-
Maintenance of basement membrane integrity
,29yo F with 5-week hx of fatigue and 4-day hx of heart palpitations and anxiety. Has primary
hypothyroidism Rx with triiodothyronine, but she has doubled the dose because of fatigue. TFT will
show which? -
ANSWER- TSH DECREASED, Free thyroxine DECREASED, Free triiodothyronine INCREASED
20yo F has multiple neurofibromas. Mom, uncle, and brothers with similar lesions. Mode of
inheritance? - ANSWER- Autosomal dominant 45yo M with yellow skin. Drinks eight to ten 12-ounce
cans of beers daily for 10 days. Liver is tender. Serum: total bili 5.9, Alk Phos 210, AST 110, ALT 69,
gamma-glutamyltransferase 25 (n = 0-30). Liver biopsy will show? - ANSWER- Mallory hyaline
50yo M smoked 2 packs per day for 34 years, with SOB on exertion, chronic cough, and
wheezing. Increased AP diameter, diminished breath
sounds, scattered rhonchi. Which Lab abnormalities is expected? - ANSWER- Increased blood HCO3
35yo M uses crack cocaine daily, with 2-hour Hx of substernal chest pain. T 37C, P 110/min, BP
160/100. Most appropriate next step? - ANSWER- Admit the patient to the hospital for possible
myocardial ischemia
54yo F with hypertension and bilateral renal artery stenosis starts taking NSAIDS for back pain. Her Cr
concentration increases from 1.0 to 5.0. Cause is due to inhibiting which? - ANSWER- Vasodilating
prostaglandins at the afferent arteriole
83yo M brought to ED after being found at home bedridden and confused. No meds. P 100/min, BP
85/50. BP unchanged after 1L IV saline. Pulmonary artery catheter shows: Cardiac output high, PCWP
low, systemic vascular resistance low. Cause of hypotension? -
ANSWER- Early septic shock
32yo M with 3-month hx of swelling and breast tenderness. Receiving thyroid hormone and steroid
replacements since removal of pituitary adenoma 2 years ago. Began hCG injections 4 months ago.
Most likely binding site of hCG causing gynecomastia? - ANSWER- Tissue:
Testicle; Effect: estradiol production
, 38yo F with 3-day hx of sore throat. Photo shown of throat. Which nerves is tested by saying "ah,"
elevating area at tip of the arrow? ANSWER- vagus
8yo boy with disruptive behavior, interrupts, always moving, trouble completing tasks. Drug with
which mechanism is appropriate? - ANSWER- Increased release of dopamine and norepinephrine
62yo M with alcohol-induced liver disease develops ascites. Infection
ruled out. Most appropriate diuretic, in addition to loops, is which? - ANSWER- Spironolactone
72yo M with weakness and fatigue. Hemoglobin concentration is 9.2,
WBC 5400, platelets 350k. Peripheral blood smear is shown. Cause? - ANSWER- Gastrointestinal blood
loss
65yo F with widely metastatic breast cancer unresponsive to chemo. No family. "close friend," at all
her visits and now she is moved to inpatient hospice after she decides she wants no further curative
therapy. Says, "We can't bear to be apart. It would be cruel to separate us now.". Which response is
appropriate? - ANSWER- "The two of you seem to have a very important relationship. Of course you
may stay together."
46yo M treated with oral cyclosporine after cardiac transplant.
Cyclosporine decreases likelihood of rejected by which actions? - ANSWER- Suppressing the early
response of T lymphocytes to activation
70yo M dies in a motor vehicle collision. Was undergoing evaluation for
occult blood in the stool. Photo of transverse colon shown. Dx? - ANSWER- Tubular adenoma
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? - ANSWER- Loratadine
QUESTIONS AND ANSWERS LATEST
2023-2024 (usmle step 1)MEDICAL
EXAMINATION LATEST UPDATES MAY 2023 A GRADE.
6yo boy from Russia with unstable gait and incoordination for 2 weeks. Pale, bulky stools for 4 years
and two episodes of bacterial pneumonia and chronic cough since age 1 year. 3%ile for height/weight.
Neuro exam shows ataxia, no DTRs, loss of proprioception. Stool shows inc fat
concentration. Vitamin deficient? - ANSWER- Vitamin E
54yo F 1 week after sudden loss of vision in left eye, returned within 1
day. 3-month hx of progressive SOB with exertion. Echocardiography
shows mass in the left atrium of the heart. Lesion is resected,
photomicrograph of it is shown. Which describes the lesion? -
ANSWER- myxoma
27yo primigravid woman at 34 weeks' with nausea and vomiting, and abdominal pain for 12 hours.
Everything's been normal. BP is now 164/102, and right upper quadrant tenderness. Labs show Hb
7.4, HCT 24%, Platelets 72k, Cr 1.2, total bili 2.3, AST 112, ALT 126. Peripheral blood smear will show? -
ANSWER- Schistocytes
60yo F 3 hours after sudden onset ankle pain. 4-year Hx of increasing serum creatinine concentrations.
Began furosemide 1 month ago, also takes glipizide. P 120/min, resp 25/min, BP 150/100. Joint fluid
shows negatively birefringent crystals. Increased risk of which complications of underlying process
causing joint findings? - ANSWER- Nephrolithiasis
56yo F follow-up 8 weeks after recovering from pneumococcal
pneumonia. Chest X-rays normal. Which allowed this resolution to occur? - ANSWER-
Maintenance of basement membrane integrity
,29yo F with 5-week hx of fatigue and 4-day hx of heart palpitations and anxiety. Has primary
hypothyroidism Rx with triiodothyronine, but she has doubled the dose because of fatigue. TFT will
show which? -
ANSWER- TSH DECREASED, Free thyroxine DECREASED, Free triiodothyronine INCREASED
20yo F has multiple neurofibromas. Mom, uncle, and brothers with similar lesions. Mode of
inheritance? - ANSWER- Autosomal dominant 45yo M with yellow skin. Drinks eight to ten 12-ounce
cans of beers daily for 10 days. Liver is tender. Serum: total bili 5.9, Alk Phos 210, AST 110, ALT 69,
gamma-glutamyltransferase 25 (n = 0-30). Liver biopsy will show? - ANSWER- Mallory hyaline
50yo M smoked 2 packs per day for 34 years, with SOB on exertion, chronic cough, and
wheezing. Increased AP diameter, diminished breath
sounds, scattered rhonchi. Which Lab abnormalities is expected? - ANSWER- Increased blood HCO3
35yo M uses crack cocaine daily, with 2-hour Hx of substernal chest pain. T 37C, P 110/min, BP
160/100. Most appropriate next step? - ANSWER- Admit the patient to the hospital for possible
myocardial ischemia
54yo F with hypertension and bilateral renal artery stenosis starts taking NSAIDS for back pain. Her Cr
concentration increases from 1.0 to 5.0. Cause is due to inhibiting which? - ANSWER- Vasodilating
prostaglandins at the afferent arteriole
83yo M brought to ED after being found at home bedridden and confused. No meds. P 100/min, BP
85/50. BP unchanged after 1L IV saline. Pulmonary artery catheter shows: Cardiac output high, PCWP
low, systemic vascular resistance low. Cause of hypotension? -
ANSWER- Early septic shock
32yo M with 3-month hx of swelling and breast tenderness. Receiving thyroid hormone and steroid
replacements since removal of pituitary adenoma 2 years ago. Began hCG injections 4 months ago.
Most likely binding site of hCG causing gynecomastia? - ANSWER- Tissue:
Testicle; Effect: estradiol production
, 38yo F with 3-day hx of sore throat. Photo shown of throat. Which nerves is tested by saying "ah,"
elevating area at tip of the arrow? ANSWER- vagus
8yo boy with disruptive behavior, interrupts, always moving, trouble completing tasks. Drug with
which mechanism is appropriate? - ANSWER- Increased release of dopamine and norepinephrine
62yo M with alcohol-induced liver disease develops ascites. Infection
ruled out. Most appropriate diuretic, in addition to loops, is which? - ANSWER- Spironolactone
72yo M with weakness and fatigue. Hemoglobin concentration is 9.2,
WBC 5400, platelets 350k. Peripheral blood smear is shown. Cause? - ANSWER- Gastrointestinal blood
loss
65yo F with widely metastatic breast cancer unresponsive to chemo. No family. "close friend," at all
her visits and now she is moved to inpatient hospice after she decides she wants no further curative
therapy. Says, "We can't bear to be apart. It would be cruel to separate us now.". Which response is
appropriate? - ANSWER- "The two of you seem to have a very important relationship. Of course you
may stay together."
46yo M treated with oral cyclosporine after cardiac transplant.
Cyclosporine decreases likelihood of rejected by which actions? - ANSWER- Suppressing the early
response of T lymphocytes to activation
70yo M dies in a motor vehicle collision. Was undergoing evaluation for
occult blood in the stool. Photo of transverse colon shown. Dx? - ANSWER- Tubular adenoma
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? - ANSWER- Loratadine
