NBME CBSE (usmle step 1)MEDICAL
ACTUAL EXAM NEWEST VERSION 2024-
2025 TESTBANK QUESTIONS AND
CORRECT DETAILED ANSWERS
|ALREADYGRADED A+
70yo M dies in a motor vehicle collision. Was undergoing
evaluation for occult blood in the stool. Photo of transverse colon
shown. Dx? - ANS>> 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? - ANS>> Loratadine
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? - ANS>> IgM
24yo M with small tender blisters on his penis 3 days after
unprotected sex. Photograph shown. Causal agent? - ANS>>
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? - ANS>>
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. Dx? - ANS>>
Malaria
68yo F with T2DM and hypertension that has been poorly
controlled despite hydrochlorothiazide treatment. BP 150/96, Labs
show serum glucose concentration of 130 and proteinuria. In
addition to current Rx, which is most appropriate
pharmacotherapy? - ANS>> Lisinopril
66yo M with stage IV colon cancer with 3-day hx of severe
diarrhea after receiving chemotherapy with fluorouracil,
leucovorin, and Irinotecan. prescribed opioid antidiarrheal agent
with no CNS effects. Which med? - ANS>> 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 gram-negative, comma-
shaped bacteria; no erythrocytes of leukocytes. MOA of toxin? -
ANS>> 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? - ANS>> 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? - ANS>> 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)? - ANS>> 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? - ANS>> 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? - ANS>> 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? -
ANS>> contemplation
, 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? - ANS>> carrier-
mediated diffusion
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? -
ANS>> scrotum
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 two
groups. Design? - ANS>> randomized clinical trial
12yo boy immersed up to his neck in 60F water for 20 minutes.
Physiological changes? - ANS>> Central blood volume
INCREASED, ADH (vasopressin) DECREASED, Atrial Natriuretic
Peptide INCREASED? C (block3, q23)
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 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? - ANS>> Failure to distinguish between statistical
significance and clinical significance
18mo girl. Separation of the umbilical cord was delayed after
birth. Has had four severe skin infections Staphylococcus aureus;
No pus formation at infection sites. Persistent leukocytosis in
ACTUAL EXAM NEWEST VERSION 2024-
2025 TESTBANK QUESTIONS AND
CORRECT DETAILED ANSWERS
|ALREADYGRADED A+
70yo M dies in a motor vehicle collision. Was undergoing
evaluation for occult blood in the stool. Photo of transverse colon
shown. Dx? - ANS>> 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? - ANS>> Loratadine
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? - ANS>> IgM
24yo M with small tender blisters on his penis 3 days after
unprotected sex. Photograph shown. Causal agent? - ANS>>
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? - ANS>>
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. Dx? - ANS>>
Malaria
68yo F with T2DM and hypertension that has been poorly
controlled despite hydrochlorothiazide treatment. BP 150/96, Labs
show serum glucose concentration of 130 and proteinuria. In
addition to current Rx, which is most appropriate
pharmacotherapy? - ANS>> Lisinopril
66yo M with stage IV colon cancer with 3-day hx of severe
diarrhea after receiving chemotherapy with fluorouracil,
leucovorin, and Irinotecan. prescribed opioid antidiarrheal agent
with no CNS effects. Which med? - ANS>> 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 gram-negative, comma-
shaped bacteria; no erythrocytes of leukocytes. MOA of toxin? -
ANS>> 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? - ANS>> 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? - ANS>> 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)? - ANS>> 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? - ANS>> 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? - ANS>> 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? -
ANS>> contemplation
, 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? - ANS>> carrier-
mediated diffusion
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? -
ANS>> scrotum
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 two
groups. Design? - ANS>> randomized clinical trial
12yo boy immersed up to his neck in 60F water for 20 minutes.
Physiological changes? - ANS>> Central blood volume
INCREASED, ADH (vasopressin) DECREASED, Atrial Natriuretic
Peptide INCREASED? C (block3, q23)
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 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? - ANS>> Failure to distinguish between statistical
significance and clinical significance
18mo girl. Separation of the umbilical cord was delayed after
birth. Has had four severe skin infections Staphylococcus aureus;
No pus formation at infection sites. Persistent leukocytosis in
