NBME CBSE ACTUAL TEST QUESTIONS AND ANSWERS(Quiz bank with all the correct answers)(usmle step 1)Medical examination

NBME CBSE ACTUAL TEST QUESTIONS

AND ANSWERS

62 year old woman - osteoporosis - a bisphosphonate is prescribed. The expected

beneficial effect of the drug is due to which of the following? Correct 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? Correct answerStatistically 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? Correct 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? Correct

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?

Correct 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? Correct 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? Correct 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? Correct

answer- Infectious Mononucleosis

57 year old man - radiation therapy for squamous cell carcinoma of the lung. Despite

therapy, tumor increases in 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? Correct 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? Correct answer- Schistosomiasis

A couple with a family history of a-thalassemia. Woman has one gene deletion and man

has two gene deletion. If the two gene is trans - what percentage of offspring will have a

two gene deletion? Correct 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? Correct 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? Correct 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? Correct answer- HDL increased

Triglycerides Decreased

73 yeare old - diffuse weakness and tingling of her arms and legs. Sensation and

vibration and position is decreased in all extremities. What vitamin deficiency? Correct

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? Correct 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? Correct 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? Correct 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 likely pathogen? Correct answera. Olfactory Nerve

Naegleria fowleri

17 year old - ED - 30 minutes after being found with a blank stare. Physical exam shows

rigidity. During exam he becomes hostile and assaults physician - Pt ingested which

drug? Correct 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? Correct answer- Significant findings

can be reported with 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? Correct answerHypogonadotropic Hypogonadism

A male stillborn is delivered at 32 weeks - Oligohydramnios - absence of a urethral

opening. Which is most likely finding? Correct 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? Correct 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? Correct 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? Correct answer- Atrophy

b. ALS = Lou Gherig

A new severe respiratory illness - Why use a killed vaccine vs a live vaccine? Correct

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 this patient's disease? Correct 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 kidney transplant. Receives a drug that induces reticulocyte

release from bone marrow and stimulates a cytokine receptor that signals Jak/Stat

pathway? Correct answer- Erythropoietin

Jak Stat - erythropoietin

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?

Correct 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 that 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? Correct 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 face (moonface). Which additional findings? Correct answerHypertension 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? Correct 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?

Correct answer- Radon

54-year-old man - intense overwhelming fear. Which portion of brain stimulated?

Correct answer- Amygdala

b. Fear = amygdala