NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS LATEST 2023-2024 (usmle step 1)MEDICAL EXAMINATION

NBME CBSE REAL EXAM 200

QUESTIONS AND ANSWERS LATEST

2023-2024 (usmle step 1)MEDICAL

EXAMINATION

70yo M dies in a motor vehicle collision. Was undergoing evaluation for

occult blood in the stool. Photo of transverse colon shown. Dx? -

ANSWER- Tubular adenoma

38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical

shows inflamed nasal mucosa. No congestion in lower lung.

Pharmacotherapy? - ANSWER- Loratadine

16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T

38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR shows

bilateral interstitial infiltrates. Blood spontaenously agglutinates while

awaiting transport to the laboratory. Antibody isotypes causing

agglutination? - ANSWER- IgM

24yo M with small tender blisters on his penis 3 days after unprotected

sex. Photograph shown. Causal agent? - ANSWER- HSV-2

42yo F with 3-year hx of an intermittent facial rash, including the

forehead, eyelids, nose, and cheeks. Rash seems to be getting worse

since she moved from New York to Florida last year. Spicy foods

precipitate a flushing reaction that seems to exacerbate the rash. PE

shows erythema over the nose and cheeks, with scattered telangiectasias

and a few papules. Dx? - ANSWER- Rosacea

53yo M returned from Africa, has fever, headache, and abdominal

discomfort. Received appropriate vaccinations prior to the trip. T 39.4C.

A wright-stained peripheral smear shown. Dx? - ANSWER- Malaria

68yo F with T2DM and hypertension that has been poorly controlled

despite hydrochlorothiazide treatment. BP 150/96, Labs show serum

glucose concentration of 130 and proteinuria. In addition to current Rx,

which is most appropriate pharmacotherapy? - ANSWER- Lisinopril

66yo M with stage IV colon cancer with 3-day hx of severe diarrhea

after receiving chemotherapy with fluorouracil, leucovorin, and

Irinotecan. prescribed opioid antidiarrheal agent with no CNS effects.

Which med? - ANSWER- Loperamide

35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had

profuse, watery diarrhea for 8 hours despite a lack of oral intake.

Recently returned from a medical relief trip to a remove village in

Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin and

decreased capillary refill. Stool for occult blood is negative; stool is gray

and turbid. Gram stain shows gram-negative, comma-shaped bacteria;

no erythrocytes of leukocytes. MOA of toxin? - ANSWER- Activation

of adenylyl cyclase

59yo F with gradual onset of lack of muscle control in her left arm and

leg. Sx 1 mo ago after dx with metastatic breast cancer. PE shows ataxia

of left upper and lower extremities. Muscle strength, DTR, sensation,

proprioception normal. Metastatic tumor in which location? -

ANSWER- cerebellum

Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows

petechial rash, microcephaly, and hepatosplenomegaly. Serologic test

for CMV: IgG + in mother, + in newborn; IGM - in mother, + in

newborn. Explanation? - ANSWER- Congenital cytomegalovirus

infection

Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at

1/5 min. PE shows a bulging, fluod0filled mass approximately 5 cm in

diameter in the midline over the lumbosacral region. No spontaneous

movements of the lower extremities. Abnormality most likely occurred

because of abnormal development during which periods of

postconception (in days)? - ANSWER- 15 to 40

64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has

ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial

fibrillation. Intravenous ibutilide is administered. Ten minutes later,

ECG shows normal sinus rhythm. Risk for which drug effect in the next

6 hours? - ANSWER- torsades de pointes

65yo F with 20-year hx of osteoarthritis of the hands now has pain

radiating down the distal anterior thigh, knee, medial leg, and food.

Bony outgrowth of vertebrae compressing one of the spinal nerves is

suspected. Nerve root in which intervertebral foramina is effected? -

ANSWER- L3 to L4

38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic

agent, he has tried diet and exercise. BMI 32. PE normal. Hb A1c is

10%. Physician recommends initiation of insulin injections. Responds,

"I know that insulin would help control my blood sugar. But a lot of

people in my family have diabetes, and insulin made them really sick at

times. Patient is at which stage of change? - ANSWER- contemplation

24yo M with 2-day history of an itchy rash on his arms and legs.

Returned from a camping trip in the woods 5 days ago. PE shows

edematous, erythematous rash with linear vesicles. Cause is activation of

which cell types? - ANSWER- T lymphocytes

70yo M from china with poorly differentiated monoclonal carcinoma of

the nasopharynx. DNA probes of neoplastic cells are most likely to

detect genome of which virus? - ANSWER- EBV

Epidemiologic study of aniline dye, 500 workers with bladder cancer

and 200 workers without. Exposed to aniline dyes/Have Bladder cancer:

Yes/Yes (250), Yes/No (50), No/Yes (250), No/No (150). Odds ratio? -

ANSWER- 3

24yo M with hx of IVDA could not be aroused. Friend reports that the

patient injected himself with a drug 6 hours ago. Labs show drug

concentration of 0.3. Assuming first-order one-compartment kinetics,

has a half-life of 2 hours, and a volume of distribution of 200 L in this

patient. What is quantity of drug (in mg) injected? - ANSWER- 480

Compound is taken up by bacterial cells. No energy is necessary for

uptake, and the compound is not concentrated in the cell. Which

describes this mechanism of transport? - ANSWER- carrier-mediated

diffusion

Newborn has male genital ducts but female external genitalia.

Cytogenetic analysis shows a 46,XY karyotype, and genetic testing

shows a mutation of the gene encoding 5alpha-reductase. In absence of

this mutation, labia majora would have been? - ANSWER- scrotum

Study designed to evaluate the efficacy of coenzyme Q10 in improving

cardiac output in patients with CHF. Sixty patients with CHF are

recruited. Each assigned by coin toss to one of two groups. Design? -

ANSWER- randomized clinical trial

12yo boy immersed up to his neck in 60F water for 20 minutes.

Physiological changes? - ANSWER- Central blood volume

INCREASED, ADH (vasopressin) DECREASED, Atrial Natriuretic

Peptide INCREASED? C (block3, q23)

Randomized controlled study of 2000 patients with insomnia is

conducted to evaluate the efficacy of a new medication to treat this

condition. Ten subjects from both the control and treatment groups do

not complete the study are not included in the analysis. Treatment group