NBME CBSE ACTUAL TEST QUESTIONS AND ANSWERS TEST BANK - COMPLETE SOLUTION RATED A
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NBME CBSE ACTUAL TEST QUESTIONS AND ANSWERS TEST BANK - COMPLETE SOLUTION RATED A
56 y/o - brought to ER - Chest Pain mowing the lawn - Hypotension, PE shows cool, clammy, diaphoretic skin. 2 hours after admission, pulmonary catherization shows pulmonary artery pressure 40/25. Left Atrial Pressu...
nbme cbse actual test questions and answers test bank complete solution rated a
nbme cbse actual test questions and answers test bank
56 yo brought to er chest pain mowing
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NBME CBSE ACTUAL TEST QUESTIONS AND ANSWERS TEST BANK -
COMPLETE SOLUTION RATED A
56 y/o - brought to ER - Chest Pain mowing the lawn - Hypotension, PE shows cool, clammy, diaphoretic
skin. 2 hours after admission, pulmonary catherization shows pulmonary artery pressure 40/25. Left
Atrial Pressure 25 g (pulmonary emboli). Compared with a healthy person- sets of pulmonary pressure
changes? Correct Answer: Hydrostatic Pressure High,
Capillary hydrostatic pressure high
Interstitial Oncotic pressure Low
cardiogenic shock, the extra blood increases capillary hydrostatic pressure, driving fluid into the
interstitial space.
67 y/o - brother has history of colon cancer. Physician recommends colonoscopy, but the patient says
she would prefer stool culture instead. Physician explains that testing the stool for occult blood is not
appropriate. Physician concerned about? Correct Answer: Low Sensitivity
A 62 y/o - 1 week of muscle cramps - trouble opening jars and using silverware. PE shows muscle
weakness and exaggerated deep tendon reflexes. What is appropriate systemic treatment for muscle
cramps and spasms? Correct Answer: agonist at GABAb Receptors
41 y/o schedule for dialysis catheters. Surgeon asks the resident to get the consent. The resident has
never seen this procedure performed and has read little about it. Which of the following actions by the
resident is most appropriate? Correct Answer: Ask attending to obtain informed consent
A 2 year old - undergoes resection of right kidney - chronic infection secondary to influx. The left kidney
is grossly normal. Which structural adaptations will eventually occur in left kidney? Correct Answer:
increase in glomerular size
Congenital solitary functioning kidney
compensatory hypertrophy of contralateral kidney
A 54 y/o woman - terminal metastatic pancreatic cancer - She asks physician to prescribe sufficient meds
to commit suicide due to unbearable pain. Physicians refuses - but will do anything to help pain.
Physician decision is most consistent with which? Correct Answer: Nonmaleficence
22 y/o woman - recently emigrated from rural Mexico - 20 minutes after generalized tonic-clonic
seizures. 6 week history of headaches, nausea, vomiting. Funduscopic exam shows bilateral
papilledema. An MRI of the brain shows enlargement of right ventricle consistent with Cysticercosis.
Which is mostly likely mechanism of hyderocephalus? Correct Answer: Obstruction of right
interventricular foramen (foramen of Monroe)
22 y/o woman - recently emigrated from rural Mexico - 20 minutes after generalized tonic-clonic
seizures. 6 week history of headaches, nausea, vomiting. Funduscopic exam shows bilateral
papilledema. An MRI of the brain shows enlargement of right ventricle consistent with Cysticercosis.
Which is mostly likely mechanism of hyderocephalus? Correct Answer: Obstruction of right
interventricular foramen (foramen of Monro)
,59 y/o - develops fatigue and decreased appetite 3 months after receive mechanical aortic valve
replacement. PE shows scleral icterus and elevated JVP. Lab studies show total bilirubin 4 elevated and
direct bilirubin 1. Which is the cause of the jaundice in this patient? Correct Answer: Hemolysis l
Plrosthetic heart valves / aortic stenosis- hemolytic anemia secondary to mechanical destruction of
RBCs.
71 y/o man - 6 month history of calf pain and discomfort when he walks. He has HTN, T2DM, weak
dorsalis pedis, and ankle brachial index. The physician knows a drug that would improve symptoms by
altering platelet function and providing direct arterial vasodilation- Which drug? Correct Answer:
Cilostazol
phosphodiesterase inhibitor; leads to increased cAMP which inhibits platelet degranulation/activation
while also causing vasodilation
A 3 month-old boy - facial abnormalities and weakness since birth. PE shows coarse facial features and
hypotonia. Mucopolysaccharides within reference range. Concentrations of lysosomal enzymes are
increased in serum and decreased in cultured skin in fibroblasts. Which of the following is decreased in
patient's lysosomal enzymes? Correct Answer: Decreased Mannose-6-phosphate
A Newborn with lethal chromosome defect. He is unable to suck sufficiently. He has episodes of crying
that occur every 2.25 hours and relieved by tube feeding. Which best describes the most appropriate
clinical approach? Correct Answer: feed by whatever necessary to maintain comfort
An 18 y/o woman - fever, sore throat, fatigue for 1 week. Temp 100.6. PE shows pharyngeal erythema,
generalized tender lymphadenopathy, splenomegaly. Lab show 20% atypical lymphocytes. Which
accounts for atypical lymphocytes in patients peripheral blood smear? Correct Answer: Reactive T -
Lymphocytes
51-year-old man - acute onset of fever and respiratory failure 6 weeks after cadaveric renal transplant.
He currently takes cyclosporine, bactrim, prednisone, and TMP_SMX. Temp high - Respirations
increased. Diffuse inspiratory and expiratory crackles. Creatinine increased. X-ray of chest shown.
Cause? Correct Answer: Cytomegalovirus
Organ transplant patients are at an increased risk of CMV pneumonia.
A 2 month old - 6 week history of constipation. She has poor feeding, sleepiness, and yellow skin. Her
parents are migrant workers and have not received routine medical care. PE shows lethargy, hypotonia,
jaundice, large fontanelles, macroglossia, and umbilical hernia. Most appropriate next step to establish
diagnosis? Correct Answer: Thyroid Function Test
CRETINISM
A 39 y/o reports bright red spots on toilet paper after defecating. Rectal examination shows large
swollen rectal veins. Which is predisposing cause of these lesions? Correct Answer: constipation
Large swollen rectal veins --> patient has external hemorrhoids.
Swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding.
The most common cause of external hemorrhoids is repeated straining while having a bowel movement.
A 45 y/o develops proteinuria and hematuria. She has taken 3g of ibuprofen for headaches daily for the
past 2 years. Which of the following is most likely obtained on renal biopsy? Correct Answer:
Tubulointerstitial nephritis
,Acute interstitial renal inflammation. Pyuria (classically eosinophils) and azotemia occurring after
administration of drugs that act as haptens, inducing hypersensitivity (eg, diuretics, NSAIDs, penicillin
derivatives, proton pump inhibitors, rifampin, quinolones, sulfonamides).
A 92 y/o - recently admitted to a nursing home because of progressive dementia has large purpuric
lesions over the dorsa of both forearms and hands. Family states shew had similar lesions over the
years. Lesions occur in absence of trauma. Platelet count is normal. Which is most likely explanation for
purpura? Correct Answer: atrophy of dermal collagen
10-year-old boy has mass in ventral midline of the neck just inferior to hyoid bone. This structure is
developed from which of the following embryonic tissues? Correct Answer: Endoderm of Foramen
caecumThe frequency of autosomal recessive disease in a population is 1/1600. A deletion has been
identified that accounts for 80% of mutations at this locus. 20% of mutations result in point mutations.
Frequency of deletion carriers in the population is closest which of the following?
A 62-year-old woman - progressive bilateral lower abdominal pain and distention. Pelvic exam shows
adnexal mass. Malignant cells. Paclitaxel is initiated. Treatment targets which in tumor? Correct Answer:
B- Tubulin
hyperstabilizes polymerized microtubules (made up of alpha- and beta- tubulin)
Taxes Stabilize society
The frequency of autosomal recessive disease in a population is 1/1600. A deletion has been identified
that accounts for 80% of mutations at this locus. 20% of mutations result in point mutations. Frequency
of deletion carriers in the population is closest which of the following? Correct Answer: 1/25
=sqrt(1/1600) = 1/40
(1/40)*80% = .02
2* 1* .02 = .04 = 1/25
A 46 y/o has dyspnea, orthopnea, midsystolic murmur best heard over the cardiac apex. An ECG shows a
left atrial abnormality. Echo shows enlarged left atrium and normal sized ventricles. Which findings?
Correct Answer: Mitral Regurgitation
A 19-year-old woman - refractory pustular acne - unresponsive to several topical and systemic therapies.
Treatment with isotretinoin. Which of the following pharmacologic effects is dependent on binding to
the RXR receptor? Correct Answer: Teratogenic effects in the embryo
hormone superfamily of nuclear receptors (NRs) that predominately function as transcription factors
with roles in development, cell differentiation, metabolism, and cell death
A 35 y/o man comes to physician because of a 2 month history of inflamed thickened silvery scales on
scalp, trunk, elbows, and knees. This condition not responsive to coal tar, calcipotriene, and
triamcinolone. Which drug is most appropriate? Correct Answer: Methotrexate
A 55-year-old with T2DM, HTN, hyperlipidemia develops myalgias with weakness. Serum CK increased.
Urine is positive for myoglobin. Which drugs responsible for symptoms? Correct Answer: Pravastatin
statin-induced myopathy
, In patients with breast cancer, metabolically stable agonists of gonadotropin-releasing hormone are
effective because they inhibit release of which? Correct Answer: Gondatropin by the pituitary Gland
GnRH agonists like Leuprolide - continuous fashion, they downregulate the GnRH receptor in the
pituitary and ultimately decrease FSH and LH.
83 y/o home bed-ridden and confused. Temp 96F. Hypotensive (BP 85/50). Given 1 liter of saline
hypotension. Pulmonary catheter inserted (Cardiac Output high, Pulmonary Cap Wedge Pressure Low,
Systemic Vascular Resistance low) - cause of hypotension? Correct Answer: Early Septic Shock
distributive shock which is marked by massive vasodilation causing decreased SVR, decreased preload /
PCWP, and increased CO
23-year old - 1-month history of weakness and muscle pain after vigorous exercise. (Family history
similar). A muscle biopsy specimen shows ragged red fibers. Mutation in a gene located in which
structure on photomicrograph? Correct Answer: Area labeled B
Mitochondrial myopathies show "ragged red fibers" on muscle biopsy due to the accumulation of
diseased mitochondria in the subsarcolemma of the muscle fiber
A 32 y/o woman - receives prescription for tetracycline and is instructed to not to take tetracycline with
milk. If tetracycline is taken with milk, its absorption is decreased due to which? Correct Answer:
Formation of complexes with mineral ions
A 23 year old F - Sjogren syndrome 6 years - she has burning pain in her toes for past month. Which
neurotransmitters is most likely mediating patients pain? Correct Answer: Substance P
undecapeptide present in the CNS and the peripheral nervous system.
involved in the synaptic transmission of pain and other nerve impulses.
22 y/o fever, chills, muscle aches. 6 hours ago - injection with Penicillin G for syphilis. Temp is 102. PE
shows no abnormalities. Which explains patient's symptoms? Correct Answer: release of bacterial
products
Administration of Penicillin for Syphilis may lead to the Jarisch-Herxheimer reaction
Herxheimer reaction is that treatment results in the sudden death and destruction of large numbers of
treponemes, with the liberation of protein products and toxins
A 48 year old - 2 hours of dizziness and palpitations with sustained, rapid, irregular heartbeat. ECG
shows AFIB. If Amiodarone administered, the patient is at greatest risk of which adverse effects? Correct
Answer: Hypothyroidism
amiodarone - associated with a number of side effects, including thyroid dysfunction (both hypo- and
hyperthyroidism
Removal of Thymus at birth results in severely impaired immune responses. However, if the thymus is
removed from adults, little if any deficit in immune responsiveness occurs because of which of the
following reasons? Correct Answer: Thymic lymphocytes produce before thymectomy are long lived
Thymus produces all of your T cells by the time you reach puberty.
By age 75, the thymus is little more than fatty tissue.
thymus produces all of your T cells by the time you reach puberty.
Thymocytes are long-lived and that's why you can lose your thymus without impairment of your
immune system.
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