NBME - NEW TESTS LATEST UPDATED 2022 QUESTIONS AND ANSWERS

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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 St... udy 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 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? Correct AnswerIncreased 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 AnswerHemopneumpothorax 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 AnswerSubmental 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 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 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 Answer-Hypogonadotropic 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 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? 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 AnswerAmygdala 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? Correct Answer-The Second CFTR Gene was 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? Correct 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 formula - Explanation for patient's sleep pattern? Correct 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 or protrude his tongue for more than 30 sec - Pt most likely has anatomic abnormalities in which of the following locations? Correct 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? Correct AnswerNormal Findings b. normal physiologic splitting 37 year old woman - right lower extremity edema - sudden SOB+, If present on physical exam which sign would be the most specific indicator or pulmonary arterial hypertension? Correct Answer-P2 louder than A2 b. Pulmonary Hypertension - Split S2 43 year old - with t2DM - ER - nausea and vomiting - after drinking champagne. Treated for Trichomonas Vaginalis Infection - TX with metronidazole. What is cause of nausea and vomiting? Correct AnswerAccumulation of Acetaldehyde b. Metronidazole - disulfiram reaction 45 year old man - right shoulder pain - patient unable to externally rotate the shoulder against resistance - Which of the following tendons is inflamed? Correct Answer-Infraspinatus b. SITS Muscles c. Teres Minor and Infraspinatus external rotation d. Innervated by Suprascapular Nerve A 44 year old man - 6 week feet numbness - chemotherapy with vincristine - MOA of Vincristine? Correct Answer-Depolymerization of Microtubules 10 year old - 95th percent height and 25th weight - Nurse thinks she has marfans - Molecular testing for FBN1 Gene shows single nucleotide change does not change amino acid at the locus - Explain the single nucleotide change in the patient and the mother? Correct Answer-It is a polymorphism 26 year old woman - ED - 2 day history of runny nose - Patient has to wait 6 hours before she is seen. In addition to apologizing, which of the following is the most appropriate remark? Correct Answer-Thank you for waiting. How can I help you today? A 26 year old man - ER -m 30 minutes after being shot in the leg - Pulse is 120/min, respirations are 16 /min - blood pressure is 80/60. Findings compared with healthy adult? Correct Answer-Baroreceptor Firing decreased SVR increased Pulmonary Vascular Resistance Increased Absorption Increased e. BARORECPTOR - stretch receptors - mirror BP - decreased in hemorrhagic shock A 36 year old man - fluid is presenting adbomen in which of the following areas as indicated by the arrow? Correct Answer-Omental Bursa (lesser sac) What is the positive predictive value (refer to chart)? Correct Answer-.67 Probability that a patient with a positive test has a disease A/(A+B) A 75 year old woman with T2DM and HTN - Emigrated from Argentina - Which of the following is the most appropriate person to serve as an interpreter for this patient encounter? Correct AnswerTelephone Interpreter During a study of renal glomeruli - if efferent arteriole is constricted - which starling forces are likely to change in the glomeruli? Correct Answer-Increased Hydrostatic Pressure 2 year old with neurocognitive dysfunction - fine during birth - both parents have learning disabilities - maternal uncle with cognitive disabilities - Irritable making eye contact with flapping his hands? Correct Answer-Trinucleotide Repeat Expansion b. Fragile X - intellectual disability - trinucleotide repeat in FMR1 gene [Show More]

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