NBME 17 ACTUAL EXAM WITH
QUESTIONS AND WELL VERIFIED
ANSWERS [REAL EXAM 100%]
38yo M truck driver 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--> less sedating antihistamine
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 (mono and mycoplasma)
24yo M with small tender blisters on his penis 3 days after unprotected sex.
Photograph shown. Causal agent? - ANS✔✔---HSV-2
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 or villous polyp. GI blood loss suggests a
risk for malignancy
,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 (ring forms in RBCs). 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✔✔---ACE I
(Lisinopril)
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after
receiving chemotherapy with flourouracil, leucovorin, and irinotecan.
Prescribed opioid antidiarrheal agent with no CNS effects. Which med? -
ANS✔✔---Loperamide
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
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 edematous,
erythematous rash with linear vesicles. Cause is activation of which cell
types? - ANS✔✔---T-lymphocytes (type IV HS)
70yo M from china with poorly differentiated monoclonal carcinoma of the
nasopharynx. DNA probes of neoplastic cells are most likely to detect
genome of which virus? - ANS✔✔---EBV
24yo M with hx of IVDA could not be aroused. Friend reports that the
patient injected himself with a drug 6 hours ago. Labs show drug
concentration of 0.3. Assuming first-order one-compartment kinetics, has a
half-life of 2 hours, and a volume of distribution of 200 L in this patient.
What is quantity of drug (in mg) injected? - ANS✔✔---= 200 (0.3) =60
3 half-lives = 120, 240, 480
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
, Corresponded to penis shaft? - ANS✔✔---Labia minora
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 tw groups. Design? - ANS✔✔---
RCT
12yo boy immersed up to his neck in 60F water for 20 minutes.
Physiological changes?
ADH:
Central Blood volume:
ANP: - ANS✔✔---ADH: decreased (VC leads to decreased ADH)
ANP: increased
Central blood volume: increased
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 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 significant and clinical significance
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 non-small cell
carcinoma. Tells patient he has lung cancer. The patient responds, "How
can this be happening to m? I eat right and exercise." Appropriate
QUESTIONS AND WELL VERIFIED
ANSWERS [REAL EXAM 100%]
38yo M truck driver 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--> less sedating antihistamine
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 (mono and mycoplasma)
24yo M with small tender blisters on his penis 3 days after unprotected sex.
Photograph shown. Causal agent? - ANS✔✔---HSV-2
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 or villous polyp. GI blood loss suggests a
risk for malignancy
,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 (ring forms in RBCs). 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✔✔---ACE I
(Lisinopril)
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after
receiving chemotherapy with flourouracil, leucovorin, and irinotecan.
Prescribed opioid antidiarrheal agent with no CNS effects. Which med? -
ANS✔✔---Loperamide
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
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 edematous,
erythematous rash with linear vesicles. Cause is activation of which cell
types? - ANS✔✔---T-lymphocytes (type IV HS)
70yo M from china with poorly differentiated monoclonal carcinoma of the
nasopharynx. DNA probes of neoplastic cells are most likely to detect
genome of which virus? - ANS✔✔---EBV
24yo M with hx of IVDA could not be aroused. Friend reports that the
patient injected himself with a drug 6 hours ago. Labs show drug
concentration of 0.3. Assuming first-order one-compartment kinetics, has a
half-life of 2 hours, and a volume of distribution of 200 L in this patient.
What is quantity of drug (in mg) injected? - ANS✔✔---= 200 (0.3) =60
3 half-lives = 120, 240, 480
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
, Corresponded to penis shaft? - ANS✔✔---Labia minora
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 tw groups. Design? - ANS✔✔---
RCT
12yo boy immersed up to his neck in 60F water for 20 minutes.
Physiological changes?
ADH:
Central Blood volume:
ANP: - ANS✔✔---ADH: decreased (VC leads to decreased ADH)
ANP: increased
Central blood volume: increased
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 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 significant and clinical significance
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 non-small cell
carcinoma. Tells patient he has lung cancer. The patient responds, "How
can this be happening to m? I eat right and exercise." Appropriate
