NBME Practice Questions And
Answers 2022 Test Bank Latest
A 67-year-old woman is hospitalized because of abdominal pain and persistent copious vomiting
for 24 hours. Two weeks ago, she was hospitalized for treatment of atrial fibrillation; after
cardioversion to a normal sinus rhythm, she began treatment with warfarin. Yesterday, at a
follow-up visit, her INR was 6 (?? normal), and her medication was discontinued. She takes no
other medications. Her temperature is 37°C (98.6°F), pulse is 120/min and regular, respirations
are 20/min, and blood pressure is 100/78 mm Hg. The abdomen is distended and moderately
tender; there is voluntary guarding in the epigastrium (??? source of pain) There are no masses,
organomegaly, or obvious hernias. Rectal examination shows no abnormalities. Test of the stool
for occult blood is negative. Her hemoglobin concentration has decreased from 13 g/dL
yesterday to 7.8 g/dL today. An ECG shows a normal sinus rhythm. Which of the following is
the most likely explanation for this patient's abdominal symptoms?
Intramural hematoma of the proximal small bowel
Internal small-bowel herniation
Malrotation of the small bowel
Intestinal ischemia from a cardiac embolus
Intussusception of the small bowel Correct Answer: Intramural hematoma of the proximal small
bowel
A 4-year-old boy is brought to the physician by his parents because of fatigue and irritability
over the past 2 months. The family visited relatives in rural Louisiana 5 months ago where the
patient ran around barefoot. The child is active and appears normal. The conjunctivae are pale.
Laboratory studies include a normal leukocyte count with 15% eosinophils. A stool preparation
discloses the parasite egg shown. Which of the following is the most likely cause of fatigue and
irritability in this patient?
Myocarditis
Circulating immune complexes
Activation of lgE
Central nervous system infestation
Microcytic anemia Correct Answer: Microcytic anemia
Two days after beginning primaquine for malaria prophylaxis, a 17-year-old African American
boy is brought to the physician because of dark urine and yellowing of his eyes. His pulse is
88/min, respirations are 12/min, and blood pressure is 124/68 mm Hg. Examination shows
scleral icterus and pale mucous membranes. His hemoglobin concentration is 10 g/dL. A blood
smear shows erythrocyte fragments and Heinz bodies. Which of the following is the most likely
explanation for these findings?
Decreased production of β-globin chains
Deficiency of glycosylphosphatidylinositol
,Deficiency of glucose 6-phosphate dehydrogenase
Fragmentation of erythrocytes by fibrin strands
Decreased porphobilinogen deaminase activity Correct Answer: Deficiency of glucose 6-
phosphate dehydrogenase
A one-day-old newborn male is found to have hemolytic disease of the newborn. Both parents
are Rh-positive, mother is positive for IgG isohemagglutinins, while father is negative. Which of
the following parental blood types most likely caused this condition?
Mother: O and Father: AB
Mother: AB and Father: O
Mother: B and Father: O
Mother: B and Father: A
Mother: O and Father: AB Correct Answer: Mother: O and Father: AB
One week after receiving 4 units of packed red blood cells for acute hemorrhage due to a gunshot
wound, a 17-year-old male develops fatigue, jaundice. Laboratory results show the
following:Hemoglobin 8.8 g/dL Hematocrit 28%, Serum total bilirubin 5 mg/dL Serum lactate
dehydrogenase 120 U/L. Liver and kidney function tests are otherwise within normal limits.
Which of the following is the most appropriate next step in diagnosis?
Ultrasonography of the gallbladder
Monospot test
Serology for hepatitis B markers
Direct and indirect antiglobulin (Coombs) tests
Cytomegalovirus antibody titer Correct Answer: Direct and indirect antiglobulin (Coombs) tests
A 6-month-old boy is brought to the physician because of left knee swelling for 24 hours. Three
months ago, he had three large hematomas on his forehead that resolved without treatment (??).
His two sisters and his mother have no history of similar symptoms. His mother's maternal uncle
and her brother died (x-linked recessive) before the age of 30 years of massive cerebral
hemorrhages. Physical examination shows deep ecchymosis over the buttocks and severe
swelling of the left knee. The most likely explanation for these findings is a deficiency of which
of the following?
Factor V (proaccelerin): Factor V Leiden (FVL) results from a point mutation in the F5 gene,
which encodes the factor V protein in the coagulation cascade. FVL renders factor V (both the
activated and inactive forms) insensitive to the actions of activated protein C (aPC), a natural
anticoagulant. As a result, individuals who carry the FVL variant are at increased risk of venous
thromboembolism (VTE). However, FVL is extremely common in the population, and many
individuals with the variant will never have a VTE.
von Willebrand factor
Factor VIII (antihemophilic factor)
Factor XIII (transglutaminase)
Factor I (fibrinogen): An abnormality of fibrinogen may be suspected if there is prolongation of
the prothrombin time (PT), activated partial thromboplastin time (aPTT), and/or thrombin time
,(TT). In congenital afibrinogenemia (absence of detectable fibrinogen), bleeding often occurs in
the neonatal period. Umbilical cord bleeding, which can be fatal, is the initial presentation in
approximately 60 to 85 percent of cases. Other individuals with afibrinogenemia may have a
later age of onset with bleeding in the skin, gastrointestinal tract, urinary tract, or central nervous
system. Joint bleeding is relatively rare. Correct Answer: Factor VIII (antihemophilic factor)
Three days after undergoing elective laparoscopic cholecystectomy for cholelithiasis, a 42-year-
old woman has the onset of hematomas at all surgical sites. She was treated for deep venous
thrombosis 3 years ago but was not taking any medications at the time of this admission. Results
of preoperative laboratory studies were within the reference range. Prior to the operation, she
received heparin and underwent application of compression stockings. Her initial postoperative
course was uncomplicated. Heronly medication is ibuprofen. She is 163 cm (5 ft 4 in) tall and
weighs 87 kg (192 lb); BMI is 33 kg/m2. Her temperature is 37.3°C(99.2°F), pulse is 94/min,
respirations are 16/min, and blood pressure is 112/74 mm Hg. Examination shows mild
hematomas at all surgical sites. The abdomen is soft and nontender. There is no organomegaly.
Bowel sounds are normal. Laboratory studies show:Hemoglobin 10.3 g/dL Hematocrit
30%Leukocyte count 12,000/mm3 Platelet count 45,000/mm3 Which of the following is the
most likely cause of this patient's current findings?
Hypersplenism
Acute intermittent porphyria
Inhibition of cyclooxygenase
von Willebrand disease
Heparin-induced thrombocytopenia Correct Answer: Heparin-induced thrombocytopenia
A 3-year-old girl with Down syndrome is brought to the physician because of a 1-week history
of frequent nosebleeds, decreased appetite, and lethargy. She takes no medications. Her
temperature is 38°C (100.4°F), pulse is 100/min, respirations are 20/min,and blood pressure is
80/45 mm Hg. Examination shows no other abnormalities except for pallor. Laboratory studies
show:Hemoglobin 6.5 g/dL Hematocrit 19%Leukocyte count 100,000/mm3 Segmented
neutrophils 15%Atypical lymphocytes 85%Platelet count 45,000/mm3 Which of the following is
the most likely mechanism of these laboratory findings?
Bone marrow hypoplasia
Iron deficiency
Reticuloendothelial phagocytosis of platelets
Serum immunoglobulin A deficiency
Infiltration of bone marrow by leukemic blasts
Lymphocyte inhibitors of erythropoiesis Correct Answer: Infiltration of bone marrow by
leukemic blasts
A 30-year-old woman, gravida 2, para 1, comes for her first prenatal visit at 26 weeks' gestation.
Uterine size is greater than expected for dates. Ultrasonography shows fetal hydrops. Which of
the following is the most appropriate next step in diagnosis?
Maternal Rh status with antibody screening
, Maternal HIV antibody test
Cervical and urine cultures for group B Streptococcus
Amniocentesis for measurement of α-fetoprotein concentration
MRI of the fetus Correct Answer: Maternal Rh status with antibody screening
A 65-year-old man has had increasingly severe headaches and diffuse muscle aches during the
past 3 months. He also has a 1-month history of jaw pain when chewing food and decreasing
visual acuity in his left eye. His temperature is 38°C (100.4°F). Visual acuity in his left eye is
20/100, and the left optic disc is slightly atrophic. His muscle strength is normal. Which of the
following tests should be obtained next?
CT scan of the head
Examination of cerebrospinal fluid
Measurement of erythrocyte sedimentation rate
Electroencephalography
Antinuclear antibody assay Correct Answer: Measurement of erythrocyte sedimentation rate
A 10-year-old boy has had anemia since birth. His spleen is five times normal size. Splenectomy
is indicated if the anemia is caused by which of the following disorders?
Fanconi anemia
Hereditary spherocytosis
Glucose 6-phosphate dehydrogenase deficiency
Thalassemia major
Sickle cell disease Correct Answer: Hereditary spherocytosis
A previously healthy 72-year-old man is brought to the physician because of weakness and
fatigue. His hemoglobin concentration is 9.2 g/dl, leukocyte count is 5400/mm3, and platelet
count is 350,000/mm3. A peripheral blood smear is shown. Which of the following is the most
likely cause of these findings?
Beta-Thalassemia major
Gastrointestinal blood loss
Aplastic anemia
Vitamin B12 (cobalamin) deficiency
Chronic myelogenous leukemia Correct Answer: Gastrointestinal blood loss
A 48-year-old man comes to the physician because of increasing bronzing of his skin, weakness,
and fatigue during the past 3 months. Physical examination shows bronzing of the skin,
hepatomegaly, and small testes. Serum studies show: Which of the following best explains the
findings in this patient?
Ferrochelatase deficiency
Increased erythropoietin production
Ineffective erythropoiesis
Transferrin deficiency
Answers 2022 Test Bank Latest
A 67-year-old woman is hospitalized because of abdominal pain and persistent copious vomiting
for 24 hours. Two weeks ago, she was hospitalized for treatment of atrial fibrillation; after
cardioversion to a normal sinus rhythm, she began treatment with warfarin. Yesterday, at a
follow-up visit, her INR was 6 (?? normal), and her medication was discontinued. She takes no
other medications. Her temperature is 37°C (98.6°F), pulse is 120/min and regular, respirations
are 20/min, and blood pressure is 100/78 mm Hg. The abdomen is distended and moderately
tender; there is voluntary guarding in the epigastrium (??? source of pain) There are no masses,
organomegaly, or obvious hernias. Rectal examination shows no abnormalities. Test of the stool
for occult blood is negative. Her hemoglobin concentration has decreased from 13 g/dL
yesterday to 7.8 g/dL today. An ECG shows a normal sinus rhythm. Which of the following is
the most likely explanation for this patient's abdominal symptoms?
Intramural hematoma of the proximal small bowel
Internal small-bowel herniation
Malrotation of the small bowel
Intestinal ischemia from a cardiac embolus
Intussusception of the small bowel Correct Answer: Intramural hematoma of the proximal small
bowel
A 4-year-old boy is brought to the physician by his parents because of fatigue and irritability
over the past 2 months. The family visited relatives in rural Louisiana 5 months ago where the
patient ran around barefoot. The child is active and appears normal. The conjunctivae are pale.
Laboratory studies include a normal leukocyte count with 15% eosinophils. A stool preparation
discloses the parasite egg shown. Which of the following is the most likely cause of fatigue and
irritability in this patient?
Myocarditis
Circulating immune complexes
Activation of lgE
Central nervous system infestation
Microcytic anemia Correct Answer: Microcytic anemia
Two days after beginning primaquine for malaria prophylaxis, a 17-year-old African American
boy is brought to the physician because of dark urine and yellowing of his eyes. His pulse is
88/min, respirations are 12/min, and blood pressure is 124/68 mm Hg. Examination shows
scleral icterus and pale mucous membranes. His hemoglobin concentration is 10 g/dL. A blood
smear shows erythrocyte fragments and Heinz bodies. Which of the following is the most likely
explanation for these findings?
Decreased production of β-globin chains
Deficiency of glycosylphosphatidylinositol
,Deficiency of glucose 6-phosphate dehydrogenase
Fragmentation of erythrocytes by fibrin strands
Decreased porphobilinogen deaminase activity Correct Answer: Deficiency of glucose 6-
phosphate dehydrogenase
A one-day-old newborn male is found to have hemolytic disease of the newborn. Both parents
are Rh-positive, mother is positive for IgG isohemagglutinins, while father is negative. Which of
the following parental blood types most likely caused this condition?
Mother: O and Father: AB
Mother: AB and Father: O
Mother: B and Father: O
Mother: B and Father: A
Mother: O and Father: AB Correct Answer: Mother: O and Father: AB
One week after receiving 4 units of packed red blood cells for acute hemorrhage due to a gunshot
wound, a 17-year-old male develops fatigue, jaundice. Laboratory results show the
following:Hemoglobin 8.8 g/dL Hematocrit 28%, Serum total bilirubin 5 mg/dL Serum lactate
dehydrogenase 120 U/L. Liver and kidney function tests are otherwise within normal limits.
Which of the following is the most appropriate next step in diagnosis?
Ultrasonography of the gallbladder
Monospot test
Serology for hepatitis B markers
Direct and indirect antiglobulin (Coombs) tests
Cytomegalovirus antibody titer Correct Answer: Direct and indirect antiglobulin (Coombs) tests
A 6-month-old boy is brought to the physician because of left knee swelling for 24 hours. Three
months ago, he had three large hematomas on his forehead that resolved without treatment (??).
His two sisters and his mother have no history of similar symptoms. His mother's maternal uncle
and her brother died (x-linked recessive) before the age of 30 years of massive cerebral
hemorrhages. Physical examination shows deep ecchymosis over the buttocks and severe
swelling of the left knee. The most likely explanation for these findings is a deficiency of which
of the following?
Factor V (proaccelerin): Factor V Leiden (FVL) results from a point mutation in the F5 gene,
which encodes the factor V protein in the coagulation cascade. FVL renders factor V (both the
activated and inactive forms) insensitive to the actions of activated protein C (aPC), a natural
anticoagulant. As a result, individuals who carry the FVL variant are at increased risk of venous
thromboembolism (VTE). However, FVL is extremely common in the population, and many
individuals with the variant will never have a VTE.
von Willebrand factor
Factor VIII (antihemophilic factor)
Factor XIII (transglutaminase)
Factor I (fibrinogen): An abnormality of fibrinogen may be suspected if there is prolongation of
the prothrombin time (PT), activated partial thromboplastin time (aPTT), and/or thrombin time
,(TT). In congenital afibrinogenemia (absence of detectable fibrinogen), bleeding often occurs in
the neonatal period. Umbilical cord bleeding, which can be fatal, is the initial presentation in
approximately 60 to 85 percent of cases. Other individuals with afibrinogenemia may have a
later age of onset with bleeding in the skin, gastrointestinal tract, urinary tract, or central nervous
system. Joint bleeding is relatively rare. Correct Answer: Factor VIII (antihemophilic factor)
Three days after undergoing elective laparoscopic cholecystectomy for cholelithiasis, a 42-year-
old woman has the onset of hematomas at all surgical sites. She was treated for deep venous
thrombosis 3 years ago but was not taking any medications at the time of this admission. Results
of preoperative laboratory studies were within the reference range. Prior to the operation, she
received heparin and underwent application of compression stockings. Her initial postoperative
course was uncomplicated. Heronly medication is ibuprofen. She is 163 cm (5 ft 4 in) tall and
weighs 87 kg (192 lb); BMI is 33 kg/m2. Her temperature is 37.3°C(99.2°F), pulse is 94/min,
respirations are 16/min, and blood pressure is 112/74 mm Hg. Examination shows mild
hematomas at all surgical sites. The abdomen is soft and nontender. There is no organomegaly.
Bowel sounds are normal. Laboratory studies show:Hemoglobin 10.3 g/dL Hematocrit
30%Leukocyte count 12,000/mm3 Platelet count 45,000/mm3 Which of the following is the
most likely cause of this patient's current findings?
Hypersplenism
Acute intermittent porphyria
Inhibition of cyclooxygenase
von Willebrand disease
Heparin-induced thrombocytopenia Correct Answer: Heparin-induced thrombocytopenia
A 3-year-old girl with Down syndrome is brought to the physician because of a 1-week history
of frequent nosebleeds, decreased appetite, and lethargy. She takes no medications. Her
temperature is 38°C (100.4°F), pulse is 100/min, respirations are 20/min,and blood pressure is
80/45 mm Hg. Examination shows no other abnormalities except for pallor. Laboratory studies
show:Hemoglobin 6.5 g/dL Hematocrit 19%Leukocyte count 100,000/mm3 Segmented
neutrophils 15%Atypical lymphocytes 85%Platelet count 45,000/mm3 Which of the following is
the most likely mechanism of these laboratory findings?
Bone marrow hypoplasia
Iron deficiency
Reticuloendothelial phagocytosis of platelets
Serum immunoglobulin A deficiency
Infiltration of bone marrow by leukemic blasts
Lymphocyte inhibitors of erythropoiesis Correct Answer: Infiltration of bone marrow by
leukemic blasts
A 30-year-old woman, gravida 2, para 1, comes for her first prenatal visit at 26 weeks' gestation.
Uterine size is greater than expected for dates. Ultrasonography shows fetal hydrops. Which of
the following is the most appropriate next step in diagnosis?
Maternal Rh status with antibody screening
, Maternal HIV antibody test
Cervical and urine cultures for group B Streptococcus
Amniocentesis for measurement of α-fetoprotein concentration
MRI of the fetus Correct Answer: Maternal Rh status with antibody screening
A 65-year-old man has had increasingly severe headaches and diffuse muscle aches during the
past 3 months. He also has a 1-month history of jaw pain when chewing food and decreasing
visual acuity in his left eye. His temperature is 38°C (100.4°F). Visual acuity in his left eye is
20/100, and the left optic disc is slightly atrophic. His muscle strength is normal. Which of the
following tests should be obtained next?
CT scan of the head
Examination of cerebrospinal fluid
Measurement of erythrocyte sedimentation rate
Electroencephalography
Antinuclear antibody assay Correct Answer: Measurement of erythrocyte sedimentation rate
A 10-year-old boy has had anemia since birth. His spleen is five times normal size. Splenectomy
is indicated if the anemia is caused by which of the following disorders?
Fanconi anemia
Hereditary spherocytosis
Glucose 6-phosphate dehydrogenase deficiency
Thalassemia major
Sickle cell disease Correct Answer: Hereditary spherocytosis
A previously healthy 72-year-old man is brought to the physician because of weakness and
fatigue. His hemoglobin concentration is 9.2 g/dl, leukocyte count is 5400/mm3, and platelet
count is 350,000/mm3. A peripheral blood smear is shown. Which of the following is the most
likely cause of these findings?
Beta-Thalassemia major
Gastrointestinal blood loss
Aplastic anemia
Vitamin B12 (cobalamin) deficiency
Chronic myelogenous leukemia Correct Answer: Gastrointestinal blood loss
A 48-year-old man comes to the physician because of increasing bronzing of his skin, weakness,
and fatigue during the past 3 months. Physical examination shows bronzing of the skin,
hepatomegaly, and small testes. Serum studies show: Which of the following best explains the
findings in this patient?
Ferrochelatase deficiency
Increased erythropoietin production
Ineffective erythropoiesis
Transferrin deficiency
