NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS LATEST (usmle step 1)MEDICAL EXAMINATION LATEST UPDATES MAY 2025 A GRADE

NBME CBSE REAL EXAM 200 i i i i i




QUESTIONS AND ANSWERS LATEST i i i




2024-2025 (usmle step 1)MEDICAL i i i




EXAMINATION LATESTUPDATES i i




MAY 2025 A GRADE. i i i




70yo M dies in a motor vehicle collision. Was undergoing evaluation for
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occult blood in the stool. Photo of transverse colon shown. Dx? -
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ANSWER- Tubular adenoma i i




38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical
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shows inflamed nasal mucosa. No congestion in lower lung.
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Pharmacotherapy? - ANSWER- Loratadine i i i




16yo girl with 3-day hx of fever, nonproductive cough, and fatigue.
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T 38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR
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shows bilateral interstitial infiltrates. Blood spontaenously agglutinates
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while
awaiting transport
agglutination? to the laboratory.
- ANSWER- IgM i Antibody isotypes causingi i i i i i i i i




24yo M with small tender blisters on his penis 3 days after unprotected
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sex. Photograph shown. Causal agent? - ANSWER- HSV-2
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42yo F with 3-year hx of an intermittent facial rash, including the
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forehead, eyelids, nose, and cheeks. Rash seems to be getting
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worse since she moved from New York to Florida last year.
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Spicy foods i

,precipitate a flushing reaction that seems to exacerbate the rash. PE
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shows erythema over the nose and cheeks, with scattered
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telangiectasias and a few papules. Dx? - ANSWER- Rosacea i i i i i i i i


53yo M returned from Africa, has fever, headache, and abdominal
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discomfort. Received appropriate vaccinations prior to the trip. T 39.4C. i i i i i i i i i



A wright-stained peripheral smear shown. Dx? - ANSWER- Malaria
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68yo F with T2DM and hypertension that has been poorly controlled
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despite hydrochlorothiazide treatment. BP 150/96, Labs show serum
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glucose concentration of 130 and proteinuria. In addition to current Rx,
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which is most appropriate pharmacotherapy? - ANSWER- Lisinopril
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66yo M with stage IV colon cancer with 3-day hx of severe diarrhea
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after receiving chemotherapy with fluorouracil, leucovorin, and
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Irinotecan. prescribed opioid antidiarrheal agent with no CNS effects.
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Which med? - ANSWER- Loperamide
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35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had
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profuse, watery diarrhea for 8 hours despite a lack of oral intake.
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Recently returned from a medical relief trip to a remove village in
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Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin andi i i i i i i i i i i i i


decreased capillary refill. Stool for occult blood is negative; stool is
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gray and turbid. Gram stain shows gram-negative, comma-shaped
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bacteria; no erythrocytes of leukocytes. MOA of toxin? - ANSWER-
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of adenylyl cyclase
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59yo F with gradual onset of lack of muscle control in her left arm and
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leg. Sx 1 mo ago after dx with metastatic breast cancer. PE shows
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ataxia of left upper and lower extremities. Muscle strength, DTR,
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sensation, proprioception normal. Metastatic tumor in which location?
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-
ANSWER- cerebellum

,Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows
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petechial rash, microcephaly, and hepatosplenomegaly. Serologic test
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for CMV: IgG + in mother, + in newborn; IGM - in mother, + in
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newborn. Explanation? - ANSWER- Congenital cytomegalovirus i i i i i i


infection
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5
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min. PE shows a bulging, fluod0filled mass approximately 5 cm in
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diameter in the midline over the lumbosacral region. No spontaneous
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movements of the lower extremities. Abnormality most likely i i i i i i i i


because of abnormal development during which periods of
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postconception (in days)? - ANSWER- 15 to 40 i i i i i i i




64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has
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ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial
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fibrillation. Intravenous ibutilide is administered. Ten minutes later, i i i i i i i i


ECG shows normal sinus rhythm. Risk for which drug effect in the next
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6 hours? - ANSWER- torsades de pointes
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65yo F with 20-year hx of osteoarthritis of the hands now has pain
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radiating down the distal anterior thigh, knee, medial leg, and
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food. Bony outgrowth of vertebrae compressing one of the spinal
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nerves is suspected. Nerve root in which intervertebral foramina is
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effected? - ANSWER- L3 to L4 i i i i i




38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic
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agent, he has tried diet and exercise. BMI 32. PE normal. Hb A1c is
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10%. Physician recommends initiation of insulin injections.
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Responds, "I know that insulin would help control my blood sugar. i i i i i i i i i i i


But a lot of people in my family have diabetes, and insulin made them
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really sick at times. Patient is at which stage of change? - ANSWER-
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contemplation
24yo M with 2-day history of an itchy rash on his arms and legs.
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Returned from a camping trip in the woods 5 days ago. PE shows
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, edematous, erythematous rash with linear vesicles. Cause is activation of i i i i i i i i i i


which cell types? - ANSWER- T lymphocytes
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70yo M from china with poorly differentiated monoclonal carcinoma of
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the nasopharynx. DNA probes of neoplastic cells are most likely to
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detect genome of which virus? - ANSWER- EBV
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Epidemiologic study of aniline dye, 500 workers with bladder cancer i i i i i i i i i i


and 200 workers without. Exposed to aniline dyes/Have Bladder
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cancer: Yes/Yes (250), Yes/No (50), No/Yes (250), No/No (150).
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Odds ratio? - i i


ANSWER- 3 i




24yo M with hx of IVDA could not be aroused. Friend reports that
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the patient injected himself with a drug 6 hours ago. Labs show
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drug concentration of 0.3. Assuming first-order one-compartment
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kinetics, has a half-life of 2 hours, and a volume of distribution of
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200 L in this patient. What is quantity of drug (in mg) injected? -
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ANSWER- 480
Compound is taken up by bacterial cells. No energy is necessary for i i i i i i i i i i i i


uptake, and the compound is not concentrated in the cell. Which
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describes this mechanism of transport? - ANSWER- carrier-mediated
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diffusion

Newborn has male genital ducts but female external genitalia.
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Cytogenetic analysis shows a 46,XY karyotype, and genetic testing i i i i i i i i


shows a mutation of the gene encoding 5alpha-reductase. In absence
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of this mutation, labia majora would have been? - ANSWER-
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scrotum
Study designed to evaluate the efficacy of coenzyme Q10 in improving
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cardiac output in patients with CHF. Sixty patients with CHF are
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recruited. Each assigned by coin toss to one of two groups. Design? -
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ANSWER- randomized clinical trial i i i