NBME CBSE ACTUAL TEST QUESTIONS AND
ANSWERS(Quiz bank with all the correct answers)(usmle
step 1)Medical examination
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.
ANSWERS(Quiz bank with all the correct answers)(usmle
step 1)Medical examination
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.
