NBME - NEW TESTS 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
Brainpower
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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
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
Brainpower
Read More
Previous
Play
Next
Rewind 10 seconds
Move forward 10 seconds
Unmute
0:01
/
0:15
Full screen
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
