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 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. A 4-week infant - vomited after feeding for past 2 days. Recent episode was very forceful regurgitation through the nostrils. Physical exam shows mild abdominal distention with visible peristalsis. Explanation of these findings? Correct Answer: Hypertrophic Pyloric Stenosis olive-shaped mass in epigastric region, A 45-year old woman - asymmetric enlargement of the thyroid gland during PE 6 weeks ago. She underwent adrenalectomy for pheochromocytoma 3 years ago. Thyroid lesions are composed of spindle cells arranged in small clusters. Deposits of amyloid are present between neoplastic cells. Foci of C-Cell Hyperplasia are also present. The lesions are confirmed as malignant. Which of the following marked is most appropriate for the development of the recurrence of the thyroid neoplasm? Correct Answer: Calcitonin Patient has medullary carcinoma. Malignant proliferation of parafollicular "C" cells that produce calcitonin and have sheets of cells in an amyloid stroma. Patient likely has MEN 2A or 2B with the presence of medullary thyroid cancer and pheochromocytoma 62 year old man - pain in left hip for 3 weeks. An x-ray of the hip shows a 4.5cm, destructive, osteoblastic lesion with associsted fracture in the proximal femur and two separate smaller lesions in the bony pelvis. A needle core biopsy of the femur shows metastic carcinoma. Which is the most likley primary site of the cancer? Correct Answer: Prostate Osteoblastic lesions are associated with prostatic adenocarcinoma mets. Increased serum ALP OB = osteoblastic OC = osteoclastic/osteolytic P=prostate, B=breast, K=kidney, T=thyroid, L=lung P--B--K--T--L P = OB B = OB/OC K = OC T = OC L = OB/OC During a clinical study, investigator tests a new drug for treatment of breast cancer. A population of 10,000 patients with breast cancer is recruited and randomized into a treatment group and control group. Analysis shows a p-value of 0.1 with no significant difference in the treatment outcomes between the experimental and control. When repeating, which is most likely to decrease making a beta error? Correct Answer: Increase sample size You are aiming to increase power and you can do so by increasing sample size (reduce B error). "power in numbers 23-year-old man - 3-year history of schizophrenia. He has been taking an antipsychotic medication for hallucinations, paranoia, and disorganized thoughts. Pt does not make eye contact. Lab show serum sodium of 120 mEq/l, urine sodium of 8, and urine osm of 80. Which is most likely cause of lab finding? Correct Answer: Psychogenic Polydipsia hyponatremia + a low ADH = psychogenic polydipsia A 12 year old - girl - 3 months ago, she sustained a complex fracture of the left tibia, which required cast immobilization. The cast is removed. Examination of the left calf shows that it is smaller than the right calf. Which of processes in the patient's myocytes is most likely cause of findings? Correct Answer: polyubiquitnation atrophy is decrease in tissue mass due to decrease in size (increased cytoskeleton degradation via ubiquitin-proteasome pathway and autophagy A 45-year-old man - tooth abscess - He has not seen a p [Show More]

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