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? -
Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? - Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer-
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? -Answer- 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? -Answer- 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? -Answer-
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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer-
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? -
Answer- Hypogonadotropic Hypogonadism
A male stillborn is delivered at 32 weeks - Oligohydramnios - absence of
a urethral opening. Which is most likely finding? -Answer- 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? -Answer- 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? -Answer- 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?
-Answer- Atrophy
b. ALS = Lou Gherig
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? -
Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? - Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer-
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? -Answer- 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? -Answer- 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? -Answer-
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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer- 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? -Answer-
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? -
Answer- Hypogonadotropic Hypogonadism
A male stillborn is delivered at 32 weeks - Oligohydramnios - absence of
a urethral opening. Which is most likely finding? -Answer- 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? -Answer- 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? -Answer- 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?
-Answer- Atrophy
b. ALS = Lou Gherig
