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NBME CBSE REAL EXAM 200
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QUESTIONS AND ANSWERS LATEST
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2023-2024 (usmle step 1)MEDICAL
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EXAMINATION LATEST UPDATES
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MAY 2023 A GRADE.
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70yo M dies in a motor vehicle collision. Was undergoing evaluation for
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occult blood in the stool. Photo of transverse colon shown. Dx? -
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ANSWER- Tubular adenoma
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38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical
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shows inflamed nasal mucosa. No congestion in lower lung.
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Pharmacotherapy? - ANSWER- Loratadine
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16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T
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38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR shows
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bilateral interstitial infiltrates. Blood spontaenously agglutinates while
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awaiting transport to the laboratory. Antibody isotypes causing
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agglutination? - ANSWER- IgM
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24yo M with small tender blisters on his penis 3 days after unprotected
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sex. Photograph shown. Causal agent? - ANSWER- HSV-2
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42yo F with 3-year hx of an intermittent facial rash, including the
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forehead, eyelids, nose, and cheeks. Rash seems to be getting worse
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since she moved from New York to Florida last year. Spicy foods
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precipitate a flushing reaction that seems to exacerbate the rash. PE
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shows erythema over the nose and cheeks, with scattered telangiectasias
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and a few papules. Dx? - ANSWER- Rosacea
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53yo M returned from Africa, has fever, headache, and abdominal
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discomfort. Received appropriate vaccinations prior to the trip. T 39.4C.
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A wright-stained peripheral smear shown. Dx? - ANSWER- Malaria
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68yo F with T2DM and hypertension that has been poorly controlled
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despite hydrochlorothiazide treatment. BP 150/96, Labs show serum
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glucose concentration of 130 and proteinuria. In addition to current Rx,
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which is most appropriate pharmacotherapy? - ANSWER- Lisinopril
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66yo M with stage IV colon cancer with 3-day hx of severe diarrhea
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after receiving chemotherapy with fluorouracil, leucovorin, and
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Irinotecan. prescribed opioid antidiarrheal agent with no CNS effects.
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Which med? - ANSWER- Loperamide
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Sp
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35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had
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profuse, watery diarrhea for 8 hours despite a lack of oral intake.
Recently returned from a medical relief trip to a remove village in
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Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin and
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decreased capillary refill. Stool for occult blood is negative; stool is gray
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and turbid. Gram stain shows gram-negative, comma-shaped bacteria;
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no erythrocytes of leukocytes. MOA of toxin? - ANSWER- Activation
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of adenylyl cyclase
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59yo F with gradual onset of lack of muscle control in her left arm and
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leg. Sx 1 mo ago after dx with metastatic breast cancer. PE shows ataxia
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of left upper and lower extremities. Muscle strength, DTR, sensation,
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proprioception normal. Metastatic tumor in which location? -
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ANSWER- cerebellum
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Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows
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petechial rash, microcephaly, and hepatosplenomegaly. Serologic test
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for CMV: IgG + in mother, + in newborn; IGM - in mother, + in
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newborn. Explanation? - ANSWER- Congenital cytomegalovirus
infection
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Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5
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min. PE shows a bulging, fluod0filled mass approximately 5 cm in
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diameter in the midline over the lumbosacral region. No spontaneous
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movements of the lower extremities. Abnormality most likely occurred
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because of abnormal development during which periods of
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postconception (in days)? - ANSWER- 15 to 40
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64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has
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ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial
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fibrillation. Intravenous ibutilide is administered. Ten minutes later,
ECG shows normal sinus rhythm. Risk for which drug effect in the next
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6 hours? - ANSWER- torsades de pointes
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65yo F with 20-year hx of osteoarthritis of the hands now has pain
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radiating down the distal anterior thigh, knee, medial leg, and food.
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Bony outgrowth of vertebrae compressing one of the spinal nerves is
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suspected. Nerve root in which intervertebral foramina is effected? -
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ANSWER- L3 to L4
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38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic
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agent, he has tried diet and exercise. BMI 32. PE normal. Hb A1c is
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10%. Physician recommends initiation of insulin injections. Responds,
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"I know that insulin would help control my blood sugar. But a lot of
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people in my family have diabetes, and insulin made them really sick at
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times. Patient is at which stage of change? - ANSWER- contemplation
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24yo M with 2-day history of an itchy rash on his arms and legs.
Returned from a camping trip in the woods 5 days ago. PE shows
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edematous, erythematous rash with linear vesicles. Cause is activation of
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which cell types? - ANSWER- T lymphocytes
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70yo M from china with poorly differentiated monoclonal carcinoma of
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the nasopharynx. DNA probes of neoplastic cells are most likely to
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detect genome of which virus? - ANSWER- EBV
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Epidemiologic study of aniline dye, 500 workers with bladder cancer
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and 200 workers without. Exposed to aniline dyes/Have Bladder cancer:
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Yes/Yes (250), Yes/No (50), No/Yes (250), No/No (150). Odds ratio? -
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ANSWER- 3
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24yo M with hx of IVDA could not be aroused. Friend reports that the
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patient injected himself with a drug 6 hours ago. Labs show drug
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concentration of 0.3. Assuming first-order one-compartment kinetics,
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has a half-life of 2 hours, and a volume of distribution of 200 L in this
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patient. What is quantity of drug (in mg) injected? - ANSWER- 480
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Compound is taken up by bacterial cells. No energy is necessary for
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uptake, and the compound is not concentrated in the cell. Which
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describes this mechanism of transport? - ANSWER- carrier-mediated
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diffusion
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Newborn has male genital ducts but female external genitalia.
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Cytogenetic analysis shows a 46,XY karyotype, and genetic testing
Sp
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shows a mutation of the gene encoding 5alpha-reductase. In absence of
this mutation, labia majora would have been? - ANSWER- scrotum
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Sp
Study designed to evaluate the efficacy of coenzyme Q10 in improving
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cardiac output in patients with CHF. Sixty patients with CHF are
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recruited. Each assigned by coin toss to one of two groups. Design? -
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ANSWER- randomized clinical trial
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Sp
sh
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NBME CBSE REAL EXAM 200
la
tz
sh
Sp
QUESTIONS AND ANSWERS LATEST
ne
la
2023-2024 (usmle step 1)MEDICAL
sh
Sp
EXAMINATION LATEST UPDATES
ne
MAY 2023 A GRADE.
la
tz
sh
Sp
ne
la
70yo M dies in a motor vehicle collision. Was undergoing evaluation for
sh
occult blood in the stool. Photo of transverse colon shown. Dx? -
Sp
ne
ANSWER- Tubular adenoma
la
tz
sh
38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical
Sp
ne
shows inflamed nasal mucosa. No congestion in lower lung.
la
Pharmacotherapy? - ANSWER- Loratadine
sh
Sp
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T
ne
38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR shows
la
bilateral interstitial infiltrates. Blood spontaenously agglutinates while
tz
awaiting transport to the laboratory. Antibody isotypes causing
sh
Sp
ne
agglutination? - ANSWER- IgM
la
sh
24yo M with small tender blisters on his penis 3 days after unprotected
Sp
sex. Photograph shown. Causal agent? - ANSWER- HSV-2
ne
a
tz
42yo F with 3-year hx of an intermittent facial rash, including the
l
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Sp
forehead, eyelids, nose, and cheeks. Rash seems to be getting worse
ne
since she moved from New York to Florida last year. Spicy foods
la
sh
Sp
la
Sp
, ne
sh
precipitate a flushing reaction that seems to exacerbate the rash. PE
ne
shows erythema over the nose and cheeks, with scattered telangiectasias
la
tz
and a few papules. Dx? - ANSWER- Rosacea
sh
Sp
53yo M returned from Africa, has fever, headache, and abdominal
ne
discomfort. Received appropriate vaccinations prior to the trip. T 39.4C.
la
A wright-stained peripheral smear shown. Dx? - ANSWER- Malaria
sh
Sp
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68yo F with T2DM and hypertension that has been poorly controlled
la
despite hydrochlorothiazide treatment. BP 150/96, Labs show serum
tz
sh
glucose concentration of 130 and proteinuria. In addition to current Rx,
Sp
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which is most appropriate pharmacotherapy? - ANSWER- Lisinopril
la
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea
sh
Sp
after receiving chemotherapy with fluorouracil, leucovorin, and
ne
Irinotecan. prescribed opioid antidiarrheal agent with no CNS effects.
la
Which med? - ANSWER- Loperamide
tz
sh
Sp
ne
35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had
la
profuse, watery diarrhea for 8 hours despite a lack of oral intake.
Recently returned from a medical relief trip to a remove village in
sh
Sp
Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin and
ne
decreased capillary refill. Stool for occult blood is negative; stool is gray
la
and turbid. Gram stain shows gram-negative, comma-shaped bacteria;
tz
sh
Sp
no erythrocytes of leukocytes. MOA of toxin? - ANSWER- Activation
ne
of adenylyl cyclase
la
sh
59yo F with gradual onset of lack of muscle control in her left arm and
Sp
leg. Sx 1 mo ago after dx with metastatic breast cancer. PE shows ataxia
ne
of left upper and lower extremities. Muscle strength, DTR, sensation,
a
tz
proprioception normal. Metastatic tumor in which location? -
l
sh
Sp
ANSWER- cerebellum
ne
la
sh
Sp
la
Sp
, ne
sh
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows
ne
petechial rash, microcephaly, and hepatosplenomegaly. Serologic test
la
tz
for CMV: IgG + in mother, + in newborn; IGM - in mother, + in
sh
Sp
newborn. Explanation? - ANSWER- Congenital cytomegalovirus
infection
ne
la
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5
sh
min. PE shows a bulging, fluod0filled mass approximately 5 cm in
Sp
diameter in the midline over the lumbosacral region. No spontaneous
ne
movements of the lower extremities. Abnormality most likely occurred
la
tz
because of abnormal development during which periods of
sh
Sp
postconception (in days)? - ANSWER- 15 to 40
ne
la
64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has
sh
ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial
Sp
ne
fibrillation. Intravenous ibutilide is administered. Ten minutes later,
ECG shows normal sinus rhythm. Risk for which drug effect in the next
la
tz
6 hours? - ANSWER- torsades de pointes
sh
Sp
ne
65yo F with 20-year hx of osteoarthritis of the hands now has pain
la
radiating down the distal anterior thigh, knee, medial leg, and food.
sh
Bony outgrowth of vertebrae compressing one of the spinal nerves is
Sp
ne
suspected. Nerve root in which intervertebral foramina is effected? -
la
ANSWER- L3 to L4
tz
sh
Sp
38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic
ne
agent, he has tried diet and exercise. BMI 32. PE normal. Hb A1c is
la
10%. Physician recommends initiation of insulin injections. Responds,
sh
Sp
"I know that insulin would help control my blood sugar. But a lot of
ne
people in my family have diabetes, and insulin made them really sick at
a
times. Patient is at which stage of change? - ANSWER- contemplation
tz
l
sh
Sp
ne
24yo M with 2-day history of an itchy rash on his arms and legs.
Returned from a camping trip in the woods 5 days ago. PE shows
la
sh
Sp
la
Sp
, ne
sh
edematous, erythematous rash with linear vesicles. Cause is activation of
ne
which cell types? - ANSWER- T lymphocytes
la
tz
sh
Sp
70yo M from china with poorly differentiated monoclonal carcinoma of
ne
the nasopharynx. DNA probes of neoplastic cells are most likely to
la
detect genome of which virus? - ANSWER- EBV
sh
Epidemiologic study of aniline dye, 500 workers with bladder cancer
Sp
ne
and 200 workers without. Exposed to aniline dyes/Have Bladder cancer:
la
Yes/Yes (250), Yes/No (50), No/Yes (250), No/No (150). Odds ratio? -
tz
ANSWER- 3
sh
Sp
ne
24yo M with hx of IVDA could not be aroused. Friend reports that the
la
patient injected himself with a drug 6 hours ago. Labs show drug
sh
Sp
concentration of 0.3. Assuming first-order one-compartment kinetics,
ne
has a half-life of 2 hours, and a volume of distribution of 200 L in this
la
patient. What is quantity of drug (in mg) injected? - ANSWER- 480
tz
sh
Sp
Compound is taken up by bacterial cells. No energy is necessary for
ne
uptake, and the compound is not concentrated in the cell. Which
la
describes this mechanism of transport? - ANSWER- carrier-mediated
sh
diffusion
Sp
ne
la
Newborn has male genital ducts but female external genitalia.
tz
sh
Cytogenetic analysis shows a 46,XY karyotype, and genetic testing
Sp
ne
shows a mutation of the gene encoding 5alpha-reductase. In absence of
this mutation, labia majora would have been? - ANSWER- scrotum
la
sh
Sp
Study designed to evaluate the efficacy of coenzyme Q10 in improving
ne
cardiac output in patients with CHF. Sixty patients with CHF are
a
tz
recruited. Each assigned by coin toss to one of two groups. Design? -
l
sh
Sp
ANSWER- randomized clinical trial
ne
la
sh
Sp
la
Sp
