NBME 16 TEST 2022 - Questions And Detailed Answers
20 yo woman with 8 yr hx of intermittent HA's, flashing lights in right visual field, f/by
unilateral THROBBING headache with NAUSEA, vomiting, with menses Ans ~
MIGRAINE HA-rmbr "POUND"--Pulsatile, One-day duration, Unilateral, Nausea, Disabling.
pulsating pain with N/photophobia/phonophobia/aura. Avoid TYRAMINE-containing
products
intense periorbital pain, tears, rhinorrhea, smoker, for 15 mins-3 hours Ans ~
Repetitive brief HA',s Excruciating periorbital pain with lacrimation and rhinorrhia. may
induce Horner syndrome, mc in males/smoker, band around head. Tx" inhaled Oxygen,
sumatriptan
80 yo old woman fracture of femur given morphine, soon her resp's are 6/min, has
PINPOINT pupils, serum Cr is 1.8mg/dL, best explan of intoxication in pt? Ans ~
morphine is metabolized to active metabolites that accumulate, she is having renal failure
possibly, PINPOINt suggests intoxication.
child, with infection that has sickle cell anemia, given prophylaxis with PCN, what is the
mcc? Ans ~ streptococcus pneumoniae is the mcc of sepsis in sickle cell patients and
splenectomy!
bulimia nervosa patient treatment? Ans ~ cognitive behavioral therapy + FLUOXETINE
(ssri)
stabbing pain noticed after shaving, pain is reproduced upon touching lateral nasal ala,
nerve supplying this region exits where in the skull? Ans ~ FORAMEN ROTUNDUM--
V2--trigeminal neuralgia
chemotherapy regimen for 55 yr old w non hodgkin lymphoma is vinblastine. normal
function of which cells and tissues resistant to this agent? Ans ~ VENTRICULAR
CARDIAC MUSCLE CELLS---vinblastine attacks rapidly dividing cells so since heart cells
don't divide, and is a PERMANENT CELL 9neurons, skeletal, cardiac m, Rbc's). all other cells
divide.
child with 6 month history of difficulty walking and leg pain, has mild atrophy of LE''s,
hammer toes, high stepping gait, cause? Ans ~ absence of MYELIN SHEATHS, this is
charcot-marie tooth dx. hereditary MOTOR & SENSORY neuropathy, also see foot
drop/scoliosis/high or flat arches. defective prodcution of proteins involved in stx/fxn of
periph nerves or myelin sheath
HCM, spinocerebellar degeneration specifically DC's (spinal ataxia), kyphoscoliosis, DM,
hammer toes Ans ~ Friedreich ataxia--initial loss of sensory (DRG), with accompanying
gait ataxia, hammer toes, AR, HCM(mc of death and bulbar dyxfunction, unable to protect
airway), impairment of mit functioning
,loss of DTR's, vibratory sense, proprioception, staggering gait, freq falling, nystagmus,
dysarthria, pes cavus, HCM, Ans ~ Friedreich ataxia
dec frataxin, GAA repeats, similar to VIT E deficiency,child 5-15 yo Ans ~ friederich
ataxia
16 yo boy dives into shallow pool that is 3 feet deep, unable to move RIGHT upper and
lower extremities, where is the lesion? Ans ~ lesion is at the lateral corticospinal tract
(CST), if lesion in the SC--always motor deficit--IPSIlateral. so here, RT sided paresis due to
right side lesion.
19 yr old girl withdrawn and isolated, uninterest, very anxious and depressed by listening
to radio that only she can hear. thinks about a government scheme to control the psychic
pain people feel. she's disheveled and malodorous. normal vital signs no abnormalities.
mentally she's distracted. she has sad mood and anxious, sad, blunted affect. best therapy?
Ans ~ patient has Schizophrenia--treat with antipsychotic--risperidone
previously healthy 52 yo F, 2 mo hx of progressive difficulty swallowing, double vision, and
slurred speech., ptosis of the eyelids and waddling gait. muscle strength shows fatigable
weakness of the neck, arms, hands, and fingers. Repetitive nerve stimulation shows a 25%
decrease in muscle action potentials in several muscles. Which of the following
mechanisms is the most likely cause of this patients disease? Ans ~ BINDING OF
AUTOAb to ACH receptor BY AN ANTIBODY--myasthenia gravis
PREV HEALTHY, young adult male, hears voices in head for 2 men for the past 2 weeks, is
afraid of physician when seen Ans ~ BRIEF, PSCYHOTOIC DISORDER, usually lasts <1
month, SUDDEN onset,
woman with progressive m. wkness and difficulty walking for 3 months, loss of Patella and
achilles tendon reflexes, wkness and DECREASED muscle bulk, sensations of
joint/position/pain/temp are normal. cause? Ans ~ DEGENERATION OF
MOTORNEURONS OF LUMBAR CORD---either ALS or poliomyelitis, patient is presenting
with LMN lesion, desruction of Anterior horn
sudden onset severe headache, right pupil is 6mm, nonreactive to light, impaired
adduction, nuchal rigidity, aneurysm to what artery? Ans ~ Pcom---posterior
communicating artery rupture--The aneurysm pressed on the oculomotor nerve and
Trochlear Nerve. The eye is blow bc the right thing to be lost on oculomotor compression is
parasympathetics then the motor. The eye can't adduct bc Superior oblique helps with
adduction thats why its difficult for people with this paralysis to go down stairs they can't
look medial and down.
21 yr old, 2 week hx of refractory back pain from MVA, asks for more opiods to manage
pain, phys exam shows no abnormilites, correct response? Ans ~ Determine which
, drugs have been prescribed for the patient in the past, want to give a nonjudgmental
response.
65-yo F, 3mo hx of HA, wknss of her arms, and left flank pain; wt loss, Physical examination
shows weakness of the proximal upper and lower extremity muscles. There is
augmentation of strength with repetitive testing of the deltoid muscles. An MRI of the brain
shows a single well-demarcated mass surrounded by edema in the right frontal lobe. A
stereotactic biopsy specimen of the lesion shows a malignant, small blue cell neoplasm that
expresses citokeratin, chromogranin, and synaptophysin. Ans ~ Pulmonary small cell
carcinoma metastatic to the brain--50% of adult brain cancers are mets, and the
augmentation of muscle strength with repeated testing suggests lambert eaton, so small
cell lung cancer metastasis
female, motor vehicle accident, symptoms of meningitis , spleen removed? Ans ~ Older
asplenic person with meningitis --> knee jerk streptococcus pneumoniae
breast cancer patient, develops increased numbness and tingling of hands and feet during
chemotherapy intervals, which drug caused it? Ans ~ Vincristine--mechanism--
microtubules for axonal transport
79 year old sustained hip fracture, gardener, wine with dinner every night, what would
help to decrease risk for additional fractures? Ans ~ WALK DAILY
76 year old lives in california, takes beta blocker for HTN, painful swelling of right big toe,
drinks homemade distilled liquor, textile factory, what is the most likely cause? Ans ~
drinking from home-distilled liquor.--CHRONIC ALCOHOL ABUSE--is a risk factor for 2nd
gout
8 year old with breast bud development and few pubic hairs, mothers asks about this,
appropriate response? Ans ~ this is NORMAL development--tanner stage II (pubarche--
pubic hair appears),
70 yo man, wife recently died, difficulty sleeping/cries, enjoys grandchildren
visits/bowling. No other depressive sx/suicidal ideation. Ans ~ schedule appts to
monitor patient;
CF patient with weakness, numbness and tingling for 3 wks, and difficulty walking, not
adherent to medication for past 6 mo's, bilat wkness and dec tendon reflexes in UE and LE,
ataxic gait, which vitamin is the cause? Ans ~ VITAMIN E!!!!
poliovirus lacks 5"mCAP, yet is still translated? why? Ans ~ no cap-->still translated
because of PRESENCE OF INTERNAL RIBOSOME ENTRY SITE--located in the 5'UTR
(untranslated region).
20 yo woman with 8 yr hx of intermittent HA's, flashing lights in right visual field, f/by
unilateral THROBBING headache with NAUSEA, vomiting, with menses Ans ~
MIGRAINE HA-rmbr "POUND"--Pulsatile, One-day duration, Unilateral, Nausea, Disabling.
pulsating pain with N/photophobia/phonophobia/aura. Avoid TYRAMINE-containing
products
intense periorbital pain, tears, rhinorrhea, smoker, for 15 mins-3 hours Ans ~
Repetitive brief HA',s Excruciating periorbital pain with lacrimation and rhinorrhia. may
induce Horner syndrome, mc in males/smoker, band around head. Tx" inhaled Oxygen,
sumatriptan
80 yo old woman fracture of femur given morphine, soon her resp's are 6/min, has
PINPOINT pupils, serum Cr is 1.8mg/dL, best explan of intoxication in pt? Ans ~
morphine is metabolized to active metabolites that accumulate, she is having renal failure
possibly, PINPOINt suggests intoxication.
child, with infection that has sickle cell anemia, given prophylaxis with PCN, what is the
mcc? Ans ~ streptococcus pneumoniae is the mcc of sepsis in sickle cell patients and
splenectomy!
bulimia nervosa patient treatment? Ans ~ cognitive behavioral therapy + FLUOXETINE
(ssri)
stabbing pain noticed after shaving, pain is reproduced upon touching lateral nasal ala,
nerve supplying this region exits where in the skull? Ans ~ FORAMEN ROTUNDUM--
V2--trigeminal neuralgia
chemotherapy regimen for 55 yr old w non hodgkin lymphoma is vinblastine. normal
function of which cells and tissues resistant to this agent? Ans ~ VENTRICULAR
CARDIAC MUSCLE CELLS---vinblastine attacks rapidly dividing cells so since heart cells
don't divide, and is a PERMANENT CELL 9neurons, skeletal, cardiac m, Rbc's). all other cells
divide.
child with 6 month history of difficulty walking and leg pain, has mild atrophy of LE''s,
hammer toes, high stepping gait, cause? Ans ~ absence of MYELIN SHEATHS, this is
charcot-marie tooth dx. hereditary MOTOR & SENSORY neuropathy, also see foot
drop/scoliosis/high or flat arches. defective prodcution of proteins involved in stx/fxn of
periph nerves or myelin sheath
HCM, spinocerebellar degeneration specifically DC's (spinal ataxia), kyphoscoliosis, DM,
hammer toes Ans ~ Friedreich ataxia--initial loss of sensory (DRG), with accompanying
gait ataxia, hammer toes, AR, HCM(mc of death and bulbar dyxfunction, unable to protect
airway), impairment of mit functioning
,loss of DTR's, vibratory sense, proprioception, staggering gait, freq falling, nystagmus,
dysarthria, pes cavus, HCM, Ans ~ Friedreich ataxia
dec frataxin, GAA repeats, similar to VIT E deficiency,child 5-15 yo Ans ~ friederich
ataxia
16 yo boy dives into shallow pool that is 3 feet deep, unable to move RIGHT upper and
lower extremities, where is the lesion? Ans ~ lesion is at the lateral corticospinal tract
(CST), if lesion in the SC--always motor deficit--IPSIlateral. so here, RT sided paresis due to
right side lesion.
19 yr old girl withdrawn and isolated, uninterest, very anxious and depressed by listening
to radio that only she can hear. thinks about a government scheme to control the psychic
pain people feel. she's disheveled and malodorous. normal vital signs no abnormalities.
mentally she's distracted. she has sad mood and anxious, sad, blunted affect. best therapy?
Ans ~ patient has Schizophrenia--treat with antipsychotic--risperidone
previously healthy 52 yo F, 2 mo hx of progressive difficulty swallowing, double vision, and
slurred speech., ptosis of the eyelids and waddling gait. muscle strength shows fatigable
weakness of the neck, arms, hands, and fingers. Repetitive nerve stimulation shows a 25%
decrease in muscle action potentials in several muscles. Which of the following
mechanisms is the most likely cause of this patients disease? Ans ~ BINDING OF
AUTOAb to ACH receptor BY AN ANTIBODY--myasthenia gravis
PREV HEALTHY, young adult male, hears voices in head for 2 men for the past 2 weeks, is
afraid of physician when seen Ans ~ BRIEF, PSCYHOTOIC DISORDER, usually lasts <1
month, SUDDEN onset,
woman with progressive m. wkness and difficulty walking for 3 months, loss of Patella and
achilles tendon reflexes, wkness and DECREASED muscle bulk, sensations of
joint/position/pain/temp are normal. cause? Ans ~ DEGENERATION OF
MOTORNEURONS OF LUMBAR CORD---either ALS or poliomyelitis, patient is presenting
with LMN lesion, desruction of Anterior horn
sudden onset severe headache, right pupil is 6mm, nonreactive to light, impaired
adduction, nuchal rigidity, aneurysm to what artery? Ans ~ Pcom---posterior
communicating artery rupture--The aneurysm pressed on the oculomotor nerve and
Trochlear Nerve. The eye is blow bc the right thing to be lost on oculomotor compression is
parasympathetics then the motor. The eye can't adduct bc Superior oblique helps with
adduction thats why its difficult for people with this paralysis to go down stairs they can't
look medial and down.
21 yr old, 2 week hx of refractory back pain from MVA, asks for more opiods to manage
pain, phys exam shows no abnormilites, correct response? Ans ~ Determine which
, drugs have been prescribed for the patient in the past, want to give a nonjudgmental
response.
65-yo F, 3mo hx of HA, wknss of her arms, and left flank pain; wt loss, Physical examination
shows weakness of the proximal upper and lower extremity muscles. There is
augmentation of strength with repetitive testing of the deltoid muscles. An MRI of the brain
shows a single well-demarcated mass surrounded by edema in the right frontal lobe. A
stereotactic biopsy specimen of the lesion shows a malignant, small blue cell neoplasm that
expresses citokeratin, chromogranin, and synaptophysin. Ans ~ Pulmonary small cell
carcinoma metastatic to the brain--50% of adult brain cancers are mets, and the
augmentation of muscle strength with repeated testing suggests lambert eaton, so small
cell lung cancer metastasis
female, motor vehicle accident, symptoms of meningitis , spleen removed? Ans ~ Older
asplenic person with meningitis --> knee jerk streptococcus pneumoniae
breast cancer patient, develops increased numbness and tingling of hands and feet during
chemotherapy intervals, which drug caused it? Ans ~ Vincristine--mechanism--
microtubules for axonal transport
79 year old sustained hip fracture, gardener, wine with dinner every night, what would
help to decrease risk for additional fractures? Ans ~ WALK DAILY
76 year old lives in california, takes beta blocker for HTN, painful swelling of right big toe,
drinks homemade distilled liquor, textile factory, what is the most likely cause? Ans ~
drinking from home-distilled liquor.--CHRONIC ALCOHOL ABUSE--is a risk factor for 2nd
gout
8 year old with breast bud development and few pubic hairs, mothers asks about this,
appropriate response? Ans ~ this is NORMAL development--tanner stage II (pubarche--
pubic hair appears),
70 yo man, wife recently died, difficulty sleeping/cries, enjoys grandchildren
visits/bowling. No other depressive sx/suicidal ideation. Ans ~ schedule appts to
monitor patient;
CF patient with weakness, numbness and tingling for 3 wks, and difficulty walking, not
adherent to medication for past 6 mo's, bilat wkness and dec tendon reflexes in UE and LE,
ataxic gait, which vitamin is the cause? Ans ~ VITAMIN E!!!!
poliovirus lacks 5"mCAP, yet is still translated? why? Ans ~ no cap-->still translated
because of PRESENCE OF INTERNAL RIBOSOME ENTRY SITE--located in the 5'UTR
(untranslated region).
