NBME CBSE REAL EXAM – 200 QUESTIONS
AND CORRECT ANSWERS | USMLE STEP 1
MEDICAL EXAMINATION STUDY GUIDE,
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? - ANSWER- 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? -
ANSWER- 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? - ANSWER-
Activation of adenylyl cyclase
Page 1 of 46
,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? - ANSWER-
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? -
ANSWER- 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)? - ANSWER- 15 to 40
70yo M dies in a motor vehicle collision. Was undergoing evaluation for
occult blood in the stool. Photo of transverse colon shown. Dx? -
ANSWER- Tubular adenoma
Page 2 of 46
,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? - ANSWER- 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? - ANSWER- IgM
24yo M with small tender blisters on his penis 3 days after unprotected sex.
Photograph shown. Causal agent? - ANSWER- 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? - ANSWER- 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? - ANSWER- Malaria
Page 3 of 46
, 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? - ANSWER- 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? - ANSWER- 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? - ANSWER- 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? -
ANSWER- T lymphocytes
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? - ANSWER- EBV
Page 4 of 46
AND CORRECT ANSWERS | USMLE STEP 1
MEDICAL EXAMINATION STUDY GUIDE,
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? - ANSWER- 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? -
ANSWER- 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? - ANSWER-
Activation of adenylyl cyclase
Page 1 of 46
,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? - ANSWER-
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? -
ANSWER- 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)? - ANSWER- 15 to 40
70yo M dies in a motor vehicle collision. Was undergoing evaluation for
occult blood in the stool. Photo of transverse colon shown. Dx? -
ANSWER- Tubular adenoma
Page 2 of 46
,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? - ANSWER- 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? - ANSWER- IgM
24yo M with small tender blisters on his penis 3 days after unprotected sex.
Photograph shown. Causal agent? - ANSWER- 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? - ANSWER- 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? - ANSWER- Malaria
Page 3 of 46
, 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? - ANSWER- 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? - ANSWER- 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? - ANSWER- 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? -
ANSWER- T lymphocytes
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? - ANSWER- EBV
Page 4 of 46
