NBME CBSE ACTUAL TEST QUESTIONS AND ANSWERS 2023-2024 COMPLETE
62 year old woman - osteoporosis - a bisphosphonate is prescribed. The expected beneficial effect of the drug is du
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
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,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 th
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 increase
Triglycerides Decreased
73 yeare old - diffuse weakness and tingling of her arms and legs. Sensation and vibration and position is decrease
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 like
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
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,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 wi
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
A new severe respiratory illness - Why use a killed vaccine vs a live vaccine? -
Answer** Avoids Concerns of reversion to virulence
b. Killed vaccines - avoids reversion to virulence
c. live vaccines - can (but rarely do) cause the disease they're designed to prevent
A 33 year old - keratinizing squamous cell carcinoma of cervix. Which of the following describes pathogenesis of th
patient's disease? -Answer** Inactivation of Cellular P53
b. p53 protein ** tumor suppressor (it activates apoptosis) - most human cancer
A 54 year old - 40 year history of T1DM - receiving hemodialysis for end stage renal disease while awaiting a kidne
transplant. Receives a drug that induces reticulocyte release from bone marrow and stimulates a cytokine recepto
that signals Jak/Stat pathway? -Answer** Erythropoietin
Jak Stat - erythropoietin
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, During a clinical study examining the effects of exercise. The average pulse is 175/min. Compared with
measurement before the session, which is most likely decreased? -Answer** Total Peripheral Resistance
An 8-year-old boy - 3-day history of fever, sore throat, and itchy eyes. Returned from week long summer camp tha
includes hiking trips and swimming - PE shows conjunctival injection and oropharyngeal edema - Outbreak among
other campers. Which is most likely cause of this patient's symptoms? -Answer** Adenovirus
Fever+ Sore Throat + Itchy Eyes transmitted via swimming pools Conjunctivitis Viral
** adenovirus
44- year-old woman - 10 month history of wide red streaks over her lower trunk (striae) and weight gain in fac
(moonface). Which additional findings? -Answer** Hypertension and muscle weakness b. Cushing - hypertension
and muscle weakness
12 year old boy - pain below left knee -unable to play soccer - An x-ray shown - Which structures attached to the
abnormal anterior tibial area? -Answer** patellar ligament
b. Osgood-Schlatter
A 65-year-old health maintenance exams - He lives is a single-family home with his cat and dog. He spend much of
his time in his basement woodworking shop. This patient is increased risk for lung cancer due to which of the
following environmental exposures? -Answer** Radon
54- year-old man - intense overwhelming fear. Which portion of brain stimulated? - Answer**
Amygdala
b. Fear ** amygdala
30 year old woman - recurrent URI - Sweat is Salty- Genetic testing for 36 most common mutations shows
detectable G551D in one allele of CFTR - What is patients clinical phenotype? -Answer** The Second CFTR Gene wa
not detected by the testing obtained
74 year old - COPD - "I enjoy coming to see you because you remind me of my daughter. She died 35 years ago".
Which is most appropriate response by
physician? -Answer** You must miss your daughter very much. Tell me about her.
b. PT ** Transference
9 month old boy - awakens and cries at least once nightly and settles back to sleep after drinking a bottle of formul
- Explanation for patient's sleep pattern?
-Answer** Normal Development
Pubertal gynecomastia in males is norma
A 32 year old - abnormal movement in hands and worse when he feels angry - Unable to fix his gaze on one point o
protrude his tongue for more than 30 sec - Pt most likely has anatomic abnormalities in which of the following
locations? - Answer** Basal Ganglia
A 14-year-old boy - recurrent otitis media since infancy - underwent tonsillectomy for obstructive sleep apnea -
Cardiac auscultation exam listen - shows S3 - which is most likely finding? -Answer**
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