NBME CBSE ACTUAL TEST

62 year old woman - osteoporosis - a bisphosphonate is prescribed. The expected

beneficial effect of the drug is due to which of the following? - Decreased Osteoclast Activity

Cohot Study of elderly women - relative risk ratio for hip fractures among those who

exercise regularly is 1.2 (95% confidence interval of 1.1 to 1.8). Which of the following is

the conclusion about the effect of exercise on the risk of hip fracture? - Statistically

Significant Overall Increase Risk

52 year old man goes to ER with chest pain radiating to his jaw while shoveling snow. Pulse

is 80/min and blood pressure is 130/70. The most immediate treatment mechanism of

action? - Increased nitric oxide concentration

24 year old woman - spilled hot grease on her left leg while working at a fast-food

restaurant. Exam of leg shows 7cm pink, soft, granular, edematous wound. The formation

of this tissue was most likely caused by increased activity of which? - a. Vascular

Endothelial Growth Factor

VEGF - stimulates angiogenesiss.

TYPE III Collagen = Blood Vessels - early wound repair

27 year old man- MVC - skull x-ray shows a linear, nondepressed basal skull fracture -

increased serum osm and decreased urin osm. Following desmopressin urine osm

increases. Desmopressin's effect is due to the activation of which of the following? - a.

Adenylyl Cyclase

Adenylate Cyclase - ATP - CAMP -- PROTEKINASE A -- Ca

v2

A 10 month old boy - 4 day history of fever and cough. He attends day care center. Chest

exam shows intercostal retractions along with bilateral, diffuse wheezes and expiratory

rhonchi. The infectious agent most likely has which of the following properties? - Mediation

of Cell Entry via a fusion protein

A 17 year old girl in ED - 15 minutes after being stung by a bee. Mild light headedness but

no difficulty swallowing- Bilateral wheezing - Which is most appropriate pharmacotherapy

for this patient? - B2- Agonist

14 year old boy - 2 day history of sore throat and fever that peaks in late afternoon. 1 week

of fatigue. He recentaly had sex with one partner. Physical exam show cervical

lymphadenopathy and pharyngeal erythema with a creamy exudate. DX? - Infectious

Mononucleosis

57 year old man - radiation therapy for squamous cell carcinoma of the lung. Despite

therapy, tumor increases in size and he dies 6 months later. The progressive tumor growth

is due to a defect in cell cycle arrest in which of the following phases of cell cycle? - G1

28 year old - lived in sub-Saharan Africa - until he came to the US. Temp of 100.4 - imaging

shows bilateral hydroureter and hydronephrosis. Biopsy shows marked fibrosis and

scattered granulomas. DX? - Schistosomiasis

A couple with a family history of a-thalassemia. Woman has one gene deletion and man has

two gene deletion. If the two gene is trans - what percentage of offspring will have a two

gene deletion? - 50%

previously healthy 40 year brought to emergency department by her husband - 2 day

history of fever, lethargy, confusion. PE shows scattered petechiae and ecchymoses over

the lower extremities - 3+ polychromasia and 3+ schistocytes and Low platelets Dx? -

Thrombotic Thrombocytopenia Purpura

16 year old boy - is admitted to the ER because of a knife wound to the left side of his chest.

An X-ray of the chest shows an air-fluid level in the left side of the chest, partial collapse of

the left lung, and the elevation of the stomach bubble. The mediastinum is midline. DX? -

Hemopneumpothorax under tension

49 year old woman - coronary artery disease - BP 140/90 - High Cholesterol, High LDL

(190), High triglycerides (350) - TX with atorvastatin and losartan. What are the effects on

HDL and Triglycerides? - HDL increased

Triglycerides Decreased

73 yeare old - diffuse weakness and tingling of her arms and legs. Sensation and vibration

and position is decreased in all extremities. What vitamin deficiency? - Vitamin B12 -

(cyanocobalamin)

Tea and Toast - low B12 in diet

15 year old girl - 3 month history of acne - which is the underlying cause of the patients

acne? - Stimulation of Sebaceous Glands by androgens

b. ACNE = Propionibacterium ACNE

4 year old from Brazil - PE shows single 12x10cm lesion in the right side of jaw with diffuse

regular edges. Photomicrographs of an incisional biopsy (looks like Burkitts Lymphoma/

Starry night) - which of the processes most likely to occur in the region indicated by the

arrow? - Apoptosis

b. Endemic Burkitt lymphoma can happen in Brazil as well as Africa (jaw lesion, puffy face).

51 year old - lump on tongue - 1 pack smoking history for 30 years. 1.5 cm mass on apex of

tongue. It is most appropriate to evaluate which lymph nodes first for evidence of

metastasis? - Submental

15 year old boy - ER - 2 hour history of confusion and agitation - fever, headache, stiff neck,

and vomiting - since returned from summer camp - patient is hallucinating - lumbar

puncture - shows cysts and trophozoites- most likely pathogen? - a. Olfactory Nerve

Naegleria fowleri

17 year old - ED - 30 minutes after being found with a blank stare. Physical exam shows

rigidity. During exam he becomes hostile and assaults physician - Pt ingested which drug? -

PCP

Placebo controlled clinical trial - 5000 pts with essential hypertension. 2500 patients

receive new drug and 2500 patients receive placebo. If alpha is set at 0.01 instead of 0.05,

which of the following is most likely result? - Significant findings can be reported with

greater confidence

17 year old - gymnast - comes to hospital because of lack of menstrual period for 6 months.

BMI 15 Which is the cause of the amenorrhea? - Hypogonadotropic Hypogonadism

A male stillborn is delivered at 32 weeks - Oligohydramnios - absence of a urethral

opening. Which is most likely finding? - Pulmonary Hypoplasia

A 6 day old - breast fed boy in ED - poor weight gain and irritability since delivery - Physical

exam shows jaundice and hepatomegaly. The concentration of which of the following

metabolites is most likely increased? - a. Galactose - 1 - phosphate

b. Congenital intolerance to breast milk

A 25-year-old man - comes to ED - severe muscle pain, diffuse, painful swelling of his neck,

underarms, and groin after camping in New Mexico Generalized scattered black maculae.

Examination of the right upper extremity shows erythematous, solid, tender mass. Mass is

draining blood and necrotic material. The most effective antibiotic for patient disorder will

interfere with which of the following processes? - a. Ribosomal Assembly

b. Yersenia Pestis

45 year old - progressive weakness - muscle fasciculations of the upper extremities and

weakness of the lower extremity - What additional findings? - Atrophy

b. ALS = Lou Gherig

A new severe respiratory illness - Why use a killed vaccine vs a live vaccine? - Avoids

Concerns of reversion to virulence

b. Killed vaccines - avoids reversion to virulence

c. live vaccines - can (but rarely do) cause the disease they're designed to prevent

A 33 year old - keratinizing squamous cell carcinoma of cervix. Which of the following

describes pathogenesis of this patient's disease? - Inactivation of Cellular P53

b. p53 protein = tumor suppressor (it activates apoptosis) - most human cancer

A 54 year old - 40 year history of T1DM - receiving hemodialysis for end stage renal disease

while awaiting a kidney transplant. Receives a drug that induces reticulocyte release from

bone marrow and stimulates a cytokine receptor that signals Jak/Stat pathway? -

Erythropoietin

Jak Stat - erythropoietin

During a clinical study examining the effects of exercise. The average pulse is 175/min.

Compared with measurement before the session, which is most likely decreased? - Total

Peripheral Resistance

An 8-year-old boy - 3-day history of fever, sore throat, and itchy eyes. Returned from week

long summer camp that includes hiking trips and swimming - PE shows conjunctival

injection and oropharyngeal edema - Outbreak among other campers. Which is most likely

cause of this patient's symptoms? - Adenovirus

Fever+ Sore Throat + Itchy Eyes

transmitted via swimming pools

Conjunctivitis Viral = adenovirus

44-year-old woman - 10 month history of wide red streaks over her lower trunk (striae)

and weight gain in face (moonface). Which additional findings? - Hypertension and muscle

weakness

b. Cushing - hypertension and muscle weakness

12 year old boy - pain below left knee -unable to play soccer - An x-ray shown - Which

structures attached to the abnormal anterior tibial area? - patellar ligament

b. Osgood-Schlatter

A 65-year-old health maintenance exams - He lives is a single-family home with his cat and

dog. He spend much of his time in his basement woodworking shop. This patient is

increased risk for lung cancer due to which of the following environmental exposures? -

Radon

54-year-old man - intense overwhelming fear. Which portion of brain stimulated? -

Amygdala

b. Fear = amygdala

30 year old woman - recurrent URI - Sweat is Salty- Genetic testing for 36 most common

mutations shows detectable G551D in one allele of CFTR - What is patients clinical

phenotype? - The Second CFTR Gene was not detected by the testing obtained

74 year old - COPD - "I enjoy coming to see you because you remind me of my daughter. She

died 35 years ago". Which is most appropriate response by physician? - You must miss your

daughter very much. Tell me about her.

b. PT = Transference

9 month old boy - awakens and cries at least once nightly and settles back to sleep after

drinking a bottle of formula - Explanation for patient's sleep pattern? - Normal

Development

Pubertal gynecomastia in males is norma

A 32 year old - abnormal movement in hands and worse when he feels angry - Unable to fix

his gaze on one point or protrude his tongue for more than 30 sec - Pt most likely has

anatomic abnormalities in which of the following locations? - Basal Ganglia

A 14-year-old boy - recurrent otitis media since infancy - underwent tonsillectomy for

obstructive sleep apnea - Cardiac auscultation exam listen - shows S3 - which is most likely

finding? - Normal Findings

b. normal physiologic splitting

37 year old woman - right lower extremity edema - sudden SOB+, If present on physical

exam which sign would be the most specific indicator or pulmonary arterial hypertension?

- P2 louder than A2

b. Pulmonary Hypertension - Split S2

43 year old - with t2DM - ER - nausea and vomiting - after drinking champagne. Treated for

Trichomonas Vaginalis Infection - TX with metronidazole. What is cause of nausea and

vomiting? - Accumulation of Acetaldehyde

b. Metronidazole - disulfiram reaction

45 year old man - right shoulder pain - patient unable to externally rotate the shoulder

against resistance - Which of the following tendons is inflamed? - Infraspinatus

b. SITS Muscles

c. Teres Minor and Infraspinatus external rotation

d. Innervated by Suprascapular Nerve

A 44 year old man - 6 week feet numbness - chemotherapy with vincristine - MOA of

Vincristine? - Depolymerization of Microtubules

10 year old - 95th percent height and 25th weight - Nurse thinks she has marfans -

Molecular testing for FBN1 Gene shows single nucleotide change does not change amino

acid at the locus - Explain the single nucleotide change in the patient and the mother? - It is

a polymorphism

26 year old woman - ED - 2 day history of runny nose - Patient has to wait 6 hours before

she is seen. In addition to apologizing, which of the following is the most appropriate

remark? - Thank you for waiting. How can I help you today?

A 26 year old man - ER -m 30 minutes after being shot in the leg - Pulse is 120/min,

respirations are 16 /min - blood pressure is 80/60. Findings compared with healthy adult?

- Baroreceptor Firing decreased

SVR increased