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NBME CBSE REAL EXAM QUESTIONS AND ANSWERS LATEST
(MEDICAL EXAMINATION) UPDATED ||COMPLETE A+ GUIDE
1. 56-year-old man comes with vague right-sided flank pain and 7-lb weight loss
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over past 6 weeks. No recent trauma or back strain. Urine is darker than usual over 2
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weeks. Renal ultrasound shows 1.5-cm solid mass in upper portion of right kidney.
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Urine shows 50 erythrocytes, 6 leukocytes, no bacteria. Dx?
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- Renal cell carcinoma
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2. 22-year-old man who is a professional cyclist undergoes extensive physiologic
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testing as part of his training regimen. His resting pulse is 33/min, and blood
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pressure is110/62 mm Hg. Echocardiography shows dilated ventricles with normal
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function and a left ventricular ejection fraction of 75%. Which of the following best
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describes the findings in this patient?
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- Eccentric hypertrophy
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3. During a clinical study of calcium and phosphorus metabolism, a 50-year-old man
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undergoes series of lab studies. His serum Ca, PO4 and PTH are normal. He is given
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infusion 2 g Calcium chloride over 2 hours. His serum Ca concentration now is
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11.5mg/dl. Compared with pre infusion levels, the serum concentration of which of
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the following substances is likely to be increased at this time?
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- 24,25-Dihydroxycholecalciferol
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4. 70-year-old man comes with skin blistering for 1 week. No oral lesions. Physical
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shows tense bullae in joint folds of upper and lower extremities. Biopsy shows
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subepidermal blister formation. Immunofluorescence microscopy shows
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antibodies against proteins at the dermal-epidermal junction. Target by antibodies?
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- Hemidesmosome
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5. 63-year-old man with abnormal blood pressure. 6 months ago, bp was 135/85.
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Today bp 170/98. Bruit heard over left renal artery. CT angio shows left arterial
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stenosis. Labs?
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- Total peripheral resistance increased, plasma renin activity increased, serum
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aldosterone concentration increased
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6. 35-year-old woman with 3-month progressive shortness of breath with exertion.
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RR 26. Physical shows jvd and prominent a wave. Lungs clear. Cardiac exam shows
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loud pulmonic component of S2 and right-sided S4 gallop. Increased pulmonary
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expression of what?
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- Endothelin-1
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7. 30-year-old woman with 2-years of numbness, blanching, and bluish color to ears,
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fingers and toes after emotional upset or cold exposure. Vitals and PE normal. Avoid
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taking which drug?
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- Phenylephrine
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8. 35-year-old woman with 2-day history of blistering lesions on sun-exposed face,
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arms and hands. Recurrent episodes of skin lesions over several years. Taking oral
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contraceptives for 15y. PE shows fluid-filled vesicles and bullae. Labs: AST
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increased, ALT increased, total porphyrin increased, urine uroporphyrin III
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increased. Precursor to uroporphyrin?
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- Succinyl CoA
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9. 65-year-old with sudden onset generalized tonic-clonic seizures. Personality
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change last 6 months; used to be mild mannered and now verbally abusive. CT
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shows single mass enhances with contrast in right frontal lobe and crosses to left
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hemisphere through corpus callosum. Dx?
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- High-grade fibrillary astrocytoma
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10. 3-week-old male newborn with recurrent vomiting after feeding since birth, and
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eager to feed after vomiting. Abdominal exam shows firm, mobile mass in
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epigastrum to right of midline. Dx description?
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- Single primary development defect
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11. 39-year-old man with 1-week of red spots on shins, joint pain and fatigue. PE
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shows purpura over lower extremities. Liver palpated 4 cm below costal margin.
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Labs: WBC 10,000, AST 142, ALT 154, hepatitis C virus RNA positive, anti-hepatitis C
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virus antibody positive, cryoglobulins positive, C4 120 (N=350-600), urine protein
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4+, urine RBC numerous. Hypersensitivity reaction?
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- Type III (immune complex-mediated)
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12. 45-year-old man with hypertension not compliant with medications. bp
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160/100. Cardiac exam shows apical impulse displaced laterally, loud S2 and S4
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gallop. Echo shows thickening of left ventricular wall. Mechanism of change in
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cardiac muscle?
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- Transcription factor c-Jun: increased, beta-myosin heave chain: increased,
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endothelin: increased
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13. 70-year-old man with early morning awakening, decreased energy, difficulty
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concentrating, anhedonia, psychomotor retardation, depressed mood for 3
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months. He had myocardial infarction and nonsustained ventricular tachycardia 2
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years ago. Tx?
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- Paroxetine
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14. 5-year-old boy with motion sickness. Planning vacation to Australia, and wants
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diphenhydramine for motion sickness. Mechanism of action for motion sickness?
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- Antagonist at muscarinic-3 (M3) receptors
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15. Newborn is found to have a cervical rib. Transformation of seventh cervical
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segment to thoracic identity. Which is true of HOX gene alteration?
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- Expression of a HOX gene normally expressed only caudal to C7
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16. 28-year-old man with ulcerative colitis, history of partial colectomy, and
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improved rectal bleeding and diarrhea since then. Meds include mesalamine,
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hydrocodone and acetaminophen. He says, "I've been taking so much of my opiate
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prescription that I ran out and stole some from my job." Next step?
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- Discuss treatment options and a referral for detoxification program
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17. 66-year-old man dies 7 days after myocardial infarction. Gross of heart shown
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(perforated interventricular wall). Histology?
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- Erythrocytes, cellular debris, macrophages, and early granulation tissue
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