NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS
LATEST (usmle step 1)MEDICAL
EXAMINATION LATEST UPDATES JUNE 2 A GRADE.
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 nonsmall
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? - ANSWER- "It must be difficult for you to accept this
diagnosis when you feel healthy."
32yo M with 6-month hx of low back pain and stiffness, worse in
morning and improve during the day; the pain radiates to his buttocks but
not down his legs. Back stiffness if he sits for prolonged periods. Which
to confirm diagnosis? - ANSWER- X-rays of the sacroiliac joints
17yo boy with 8-kg weight gain during the past year. No medical illness.
BMI is 32. He asks, "Do you think that my weight gain is inherited from
my father?" Appropriate response? - ANSWER- "Yes, your weight gain
can be caused by genes and environment combined."
52yo M neighbors have reported that he has been confused and not
taking care of himself. 4-mo Hx of diarrhea. PE shows extreme muscle
wasting, stomatitis, and a diffuse rash that is worse in sun-exposed areas.
Diagnosis? - ANSWER- pellagra
,80yo F with suspected temporal arteritis (TA). ESR is 100, Pretest
probability for TA is 50% in this patient. In the evaluation of TA, ESR
has a sensitivity of 99% and specificity of 60%. Based on the results of
the ESR testing, most appropriate next step? - ANSWER- Additional
testing to confirm the diagnosis of TA
Sequence surrounding the first two exons of the human beta-globin gene
shown, with exons in bold. Translation start codon is underlined. A
mutation from G-->A at position 355 is most likely to lead to beta-
thalassemia by which mechanism? - ANSWER- Disruption of normal
splicing by creation of a new 3' splice site?
42yo M in ED because of a 10-day history of progressive fever, SOB,
and nonproductive cough. 20-kg weight loss. Immigrated to USA from
the Ivory Coast 4 years ago. Temp 38C. Lungs clear, CXr shows diffuse
interstitial infiltrate. Silver stain obtained via bronchoscopy shows
Pneumocystis jiroveci (formerly P. carinii). High dose prednisone and
27trimethoprimyo F with vaginal bleeding for 3 weeks. First pregnancy
ende-sulfamethoxazole is initiated, and workup for HIVd with a
infection is done. HIV ELISA positive, HIV western blot positive,
Cspontaneous abortion 8 months ago. No Rx since dilatation and
curettD4ag e
22; HIV viral load <50. Explanation? - ANSWER- Infection with HIV-2
at that time. PE shows enlarged uterus, beta-hCG markedly increased.
Ultrasonagraphy of pelvis shows material within the endometrial cavity
and no intrauterine pregnancy. CT scan shows a necrotic intrauterine
mass and metastatic nodules in the lungs. Site of Origin? - ANSWER-
trophoblastic tissue
, 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? - ANSWER-
Activation
of adenylyl cyclase
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? - 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, 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)? - ANSWER- 15 to 40
, 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? - 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? -
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? - 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
LATEST (usmle step 1)MEDICAL
EXAMINATION LATEST UPDATES JUNE 2 A GRADE.
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 nonsmall
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? - ANSWER- "It must be difficult for you to accept this
diagnosis when you feel healthy."
32yo M with 6-month hx of low back pain and stiffness, worse in
morning and improve during the day; the pain radiates to his buttocks but
not down his legs. Back stiffness if he sits for prolonged periods. Which
to confirm diagnosis? - ANSWER- X-rays of the sacroiliac joints
17yo boy with 8-kg weight gain during the past year. No medical illness.
BMI is 32. He asks, "Do you think that my weight gain is inherited from
my father?" Appropriate response? - ANSWER- "Yes, your weight gain
can be caused by genes and environment combined."
52yo M neighbors have reported that he has been confused and not
taking care of himself. 4-mo Hx of diarrhea. PE shows extreme muscle
wasting, stomatitis, and a diffuse rash that is worse in sun-exposed areas.
Diagnosis? - ANSWER- pellagra
,80yo F with suspected temporal arteritis (TA). ESR is 100, Pretest
probability for TA is 50% in this patient. In the evaluation of TA, ESR
has a sensitivity of 99% and specificity of 60%. Based on the results of
the ESR testing, most appropriate next step? - ANSWER- Additional
testing to confirm the diagnosis of TA
Sequence surrounding the first two exons of the human beta-globin gene
shown, with exons in bold. Translation start codon is underlined. A
mutation from G-->A at position 355 is most likely to lead to beta-
thalassemia by which mechanism? - ANSWER- Disruption of normal
splicing by creation of a new 3' splice site?
42yo M in ED because of a 10-day history of progressive fever, SOB,
and nonproductive cough. 20-kg weight loss. Immigrated to USA from
the Ivory Coast 4 years ago. Temp 38C. Lungs clear, CXr shows diffuse
interstitial infiltrate. Silver stain obtained via bronchoscopy shows
Pneumocystis jiroveci (formerly P. carinii). High dose prednisone and
27trimethoprimyo F with vaginal bleeding for 3 weeks. First pregnancy
ende-sulfamethoxazole is initiated, and workup for HIVd with a
infection is done. HIV ELISA positive, HIV western blot positive,
Cspontaneous abortion 8 months ago. No Rx since dilatation and
curettD4ag e
22; HIV viral load <50. Explanation? - ANSWER- Infection with HIV-2
at that time. PE shows enlarged uterus, beta-hCG markedly increased.
Ultrasonagraphy of pelvis shows material within the endometrial cavity
and no intrauterine pregnancy. CT scan shows a necrotic intrauterine
mass and metastatic nodules in the lungs. Site of Origin? - ANSWER-
trophoblastic tissue
, 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? - ANSWER-
Activation
of adenylyl cyclase
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? - 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, 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)? - ANSWER- 15 to 40
, 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? - 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? -
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? - 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
