NBME EXAM PREP
( Questions and Answers)
Verified 2023
, NBME EXAM PREP Questions and Answers 2023
1. Block 1 part 1
1. 56-year-old man comes with vague right-sided flank pain and 7-lb weight loss over past 6 weeks. No recent trauma or back strain. Urine is darker than usual over 2 weeks.
Renal ultrasound shows 1.5-cm solid mass in upper portion of right kidney. Urine shows 50 erythrocytes, 6 leukocytes, no bacteria. Dx?
- Renal cell carcinoma
2. 22-year-old man who is a professional cyclist undergoes extensive physiologic testing as part of his training regimen. His resting pulse is 33/min, and blood pressure is110/62
mm Hg. Echocardiography shows dilated ventricles with normal function and a left ventricular ejection fraction of 75%. Which of the following best describes the findings in this
patient?
- Eccentric hypertrophy
3. During a clinical study of calcium and phosphorus metabolism, a 50-year-old man undergoes series of lab studies. His serum Ca, PO4 and PTH are normal. He is given
infusion 2 g Calcium chloride over 2 hours. His serum Ca concentration now is 11.5mg/dl. Compared with pre infusion levels, the serum concentration of which of the following
substances is likely to be increased at this time?
- 24,25-Dihydroxycholecalciferol
4. 70-year-old man comes with skin blistering for 1 week. No oral lesions. Physical shows tense bullae in joint folds of upper and lower extremities. Biopsy shows subepidermal
blister formation. Immunofluorescence microscopy shows antibodies against proteins at the dermal-epidermal junction. Target by antibodies?
- Hemidesmosome
5. 63-year-old man with abnormal blood pressure. 6 months ago, bp was 135/85. Today bp 170/98. Bruit heard over left renal artery. CT angio shows left arterial stenosis.
Labs?
- Total peripheral resistance increased, plasma renin activity increased, serum aldosterone concentration increased
6. 35-year-old woman with 3-month progressive shortness of breath with exertion. RR 26. Physical shows jvd and prominent a wave. Lungs clear. Cardiac exam shows loud
pulmonic component of S2 and right-sided S4 gallop. Increased pulmonary expression of what?
- Endothelin-1
7. 30-year-old woman with 2-years of numbness, blanching, and bluish color to ears, fingers and toes after emotional upset or cold exposure. Vitals and PE normal. Avoid taking
which drug?
- Phenylephrine
8. 35-year-old woman with 2-day history of blistering lesions on sun-exposed face, arms and hands. Recurrent episodes of skin lesions over several years. Taking oral
contraceptives for 15y. PE shows fluid-filled vesicles and bullae. Labs: AST increased, ALT increased, total porphyrin increased, urine uroporphyrin III increased. Precursor to
uroporphyrin?
- Succinyl CoA
9. 65-year-old with sudden onset generalized tonic-clonic seizures. Personality change last 6 months; used to be mild mannered and now verbally abusive. CT shows single
mass enhances with contrast in right frontal lobe and crosses to left hemisphere through corpus callosum. Dx?
- High-grade fibrillary astrocytoma
10. 3-week-old male newborn with recurrent vomiting after feeding since birth, and eager to feed after vomiting. Abdominal exam shows firm, mobile mass in epigastrum to right
of midline. Dx description?
- Single primary development defect
11. 39-year-old man with 1-week of red spots on shins, joint pain and fatigue. PE shows purpura over lower extremities. Liver palpated 4 cm below costal margin. Labs: WBC
10,000, AST 142, ALT 154, hepatitis C virus RNA positive, anti-hepatitis C virus antibody positive, cryoglobulins positive, C4 120 (N=350-600), urine protein 4+, urine RBC
numerous. Hypersensitivity reaction?
- Type III (immune complex-mediated)
12. 45-year-old man with hypertension not compliant with medications. bp 160/100. Cardiac exam shows apical impulse displaced laterally, loud S2 and S4 gallop. Echo shows
thickening of left ventricular wall. Mechanism of change in cardiac muscle?
- Transcription factor c-Jun: increased, beta-myosin heave chain: increased, endothelin: increased
13. 70-year-old man with early morning awakening, decreased energy, difficulty concentrating, anhedonia, psychomotor retardation, depressed mood for 3 months. He had
myocardial infarction and nonsustained ventricular tachycardia 2 years ago. Tx?
- Paroxetine
14. 5-year-old boy with motion sickness. Planning vacation to Australia, and wants diphenhydramine for motion sickness. Mechanism of action for motion sickness?
- Antagonist at muscarinic-3 (M3) receptors
15. Newborn is found to have a cervical rib. Transformation of seventh cervical segment to thoracic identity. Which is true of HOX gene alteration?
- Expression of a HOX gene normally expressed only caudal to C7
16. 28-year-old man with ulcerative colitis, history of partial colectomy, and improved rectal bleeding and diarrhea since then. Meds include mesalamine, hydrocodone and
acetaminophen. He says, "I've been taking so much of my opiate prescription that I ran out and stole some from my job." Next step?
- Discuss treatment options and a referral for detoxification program
17. 66-year-old man dies 7 days after myocardial infarction. Gross of heart shown (perforated interventricular wall). Histology?
- Erythrocytes, cellular debris, macrophages, and early granulation tissue
18. 16-year-old boy who frequently thinks about sex, daydreams about girls before going to sleep, and masturbates one to two times daily. After counseling about safe sex, best
next step?
- Schedule next routine examination
19. 18-year-old man comes with cracked lips and peeling sunburned skin. Works as lifeguard. PE shows desquamation of sunburned skin. Lips are dry and cracked. Petrolatum
to lips may reduce lip symptoms by which of following effects of the compound?
- Barrier
20. 29-year-old woman comes to the physician because of irregular menstrual periods since menarche at the age of 12. She is 5.3Ft and weighs 86kgs. BMI 34. She is
evaluated and a diagnosis of PCOS is made. After explaining the diagnosis, the physician discusses behavioral changes, including dietary modification and exercise as part of
her treatment. Which of the following will ensure adherence?
- Provide follow ups to monitor progress in attaining her goal
21. 30-year-old man in bicycle collision and hits right shoulder forcefully. Unable to flex right elbow with decreased sensation to pinprick over right lateral forearm. Brachial
plexus lesion?
- E (musculocutaneous nerve)
22. 67-year-old man with 1 year progressive difficulty writing and walking. Pt is stooped and talks slowly. PE shows bland facial expression, fine resting tremor in both hands, no
tremor when moves, walks with difficulty starting and stopping, cogwheel rigidity. Brain tissue histology shown as well as gross cross sections of midbrain both normal and
diseased. Substance referred to by arrow?
- Alpha-synuclein
Dr G Bhanu Prakash
( Questions and Answers)
Verified 2023
, NBME EXAM PREP Questions and Answers 2023
1. Block 1 part 1
1. 56-year-old man comes with vague right-sided flank pain and 7-lb weight loss over past 6 weeks. No recent trauma or back strain. Urine is darker than usual over 2 weeks.
Renal ultrasound shows 1.5-cm solid mass in upper portion of right kidney. Urine shows 50 erythrocytes, 6 leukocytes, no bacteria. Dx?
- Renal cell carcinoma
2. 22-year-old man who is a professional cyclist undergoes extensive physiologic testing as part of his training regimen. His resting pulse is 33/min, and blood pressure is110/62
mm Hg. Echocardiography shows dilated ventricles with normal function and a left ventricular ejection fraction of 75%. Which of the following best describes the findings in this
patient?
- Eccentric hypertrophy
3. During a clinical study of calcium and phosphorus metabolism, a 50-year-old man undergoes series of lab studies. His serum Ca, PO4 and PTH are normal. He is given
infusion 2 g Calcium chloride over 2 hours. His serum Ca concentration now is 11.5mg/dl. Compared with pre infusion levels, the serum concentration of which of the following
substances is likely to be increased at this time?
- 24,25-Dihydroxycholecalciferol
4. 70-year-old man comes with skin blistering for 1 week. No oral lesions. Physical shows tense bullae in joint folds of upper and lower extremities. Biopsy shows subepidermal
blister formation. Immunofluorescence microscopy shows antibodies against proteins at the dermal-epidermal junction. Target by antibodies?
- Hemidesmosome
5. 63-year-old man with abnormal blood pressure. 6 months ago, bp was 135/85. Today bp 170/98. Bruit heard over left renal artery. CT angio shows left arterial stenosis.
Labs?
- Total peripheral resistance increased, plasma renin activity increased, serum aldosterone concentration increased
6. 35-year-old woman with 3-month progressive shortness of breath with exertion. RR 26. Physical shows jvd and prominent a wave. Lungs clear. Cardiac exam shows loud
pulmonic component of S2 and right-sided S4 gallop. Increased pulmonary expression of what?
- Endothelin-1
7. 30-year-old woman with 2-years of numbness, blanching, and bluish color to ears, fingers and toes after emotional upset or cold exposure. Vitals and PE normal. Avoid taking
which drug?
- Phenylephrine
8. 35-year-old woman with 2-day history of blistering lesions on sun-exposed face, arms and hands. Recurrent episodes of skin lesions over several years. Taking oral
contraceptives for 15y. PE shows fluid-filled vesicles and bullae. Labs: AST increased, ALT increased, total porphyrin increased, urine uroporphyrin III increased. Precursor to
uroporphyrin?
- Succinyl CoA
9. 65-year-old with sudden onset generalized tonic-clonic seizures. Personality change last 6 months; used to be mild mannered and now verbally abusive. CT shows single
mass enhances with contrast in right frontal lobe and crosses to left hemisphere through corpus callosum. Dx?
- High-grade fibrillary astrocytoma
10. 3-week-old male newborn with recurrent vomiting after feeding since birth, and eager to feed after vomiting. Abdominal exam shows firm, mobile mass in epigastrum to right
of midline. Dx description?
- Single primary development defect
11. 39-year-old man with 1-week of red spots on shins, joint pain and fatigue. PE shows purpura over lower extremities. Liver palpated 4 cm below costal margin. Labs: WBC
10,000, AST 142, ALT 154, hepatitis C virus RNA positive, anti-hepatitis C virus antibody positive, cryoglobulins positive, C4 120 (N=350-600), urine protein 4+, urine RBC
numerous. Hypersensitivity reaction?
- Type III (immune complex-mediated)
12. 45-year-old man with hypertension not compliant with medications. bp 160/100. Cardiac exam shows apical impulse displaced laterally, loud S2 and S4 gallop. Echo shows
thickening of left ventricular wall. Mechanism of change in cardiac muscle?
- Transcription factor c-Jun: increased, beta-myosin heave chain: increased, endothelin: increased
13. 70-year-old man with early morning awakening, decreased energy, difficulty concentrating, anhedonia, psychomotor retardation, depressed mood for 3 months. He had
myocardial infarction and nonsustained ventricular tachycardia 2 years ago. Tx?
- Paroxetine
14. 5-year-old boy with motion sickness. Planning vacation to Australia, and wants diphenhydramine for motion sickness. Mechanism of action for motion sickness?
- Antagonist at muscarinic-3 (M3) receptors
15. Newborn is found to have a cervical rib. Transformation of seventh cervical segment to thoracic identity. Which is true of HOX gene alteration?
- Expression of a HOX gene normally expressed only caudal to C7
16. 28-year-old man with ulcerative colitis, history of partial colectomy, and improved rectal bleeding and diarrhea since then. Meds include mesalamine, hydrocodone and
acetaminophen. He says, "I've been taking so much of my opiate prescription that I ran out and stole some from my job." Next step?
- Discuss treatment options and a referral for detoxification program
17. 66-year-old man dies 7 days after myocardial infarction. Gross of heart shown (perforated interventricular wall). Histology?
- Erythrocytes, cellular debris, macrophages, and early granulation tissue
18. 16-year-old boy who frequently thinks about sex, daydreams about girls before going to sleep, and masturbates one to two times daily. After counseling about safe sex, best
next step?
- Schedule next routine examination
19. 18-year-old man comes with cracked lips and peeling sunburned skin. Works as lifeguard. PE shows desquamation of sunburned skin. Lips are dry and cracked. Petrolatum
to lips may reduce lip symptoms by which of following effects of the compound?
- Barrier
20. 29-year-old woman comes to the physician because of irregular menstrual periods since menarche at the age of 12. She is 5.3Ft and weighs 86kgs. BMI 34. She is
evaluated and a diagnosis of PCOS is made. After explaining the diagnosis, the physician discusses behavioral changes, including dietary modification and exercise as part of
her treatment. Which of the following will ensure adherence?
- Provide follow ups to monitor progress in attaining her goal
21. 30-year-old man in bicycle collision and hits right shoulder forcefully. Unable to flex right elbow with decreased sensation to pinprick over right lateral forearm. Brachial
plexus lesion?
- E (musculocutaneous nerve)
22. 67-year-old man with 1 year progressive difficulty writing and walking. Pt is stooped and talks slowly. PE shows bland facial expression, fine resting tremor in both hands, no
tremor when moves, walks with difficulty starting and stopping, cogwheel rigidity. Brain tissue histology shown as well as gross cross sections of midbrain both normal and
diseased. Substance referred to by arrow?
- Alpha-synuclein
Dr G Bhanu Prakash
