NBME 15 Questions and Answers

orthopod · Jul 2, 2016

@Mohammad Taha I can't send you the actual form. However, if you use the search function (ctrl + F), you should be able to search for the key words from the question you are looking for. Hope this helps.

Mohammad Taha · Jul 8, 2016

Block 3 / Q36
The right answer is supposed to be H not J.

orthopod · Jul 10, 2016

@Mohammad Taha what makes you think the answer should be H?

Mohammad Taha · Jul 10, 2016

The vignette shows that the affected area is Wernck's area which is denoted by letter H in the question stem.

myoungren · Jul 31, 2016

Hey Orthopod, great stuff here! For #2, my answer was "subjective nature of survey instrument," but I got it wrong. Any ideas as to what could be the right answer?

Thanks!
Marguerite

orthopod said: ↑

Block 1 part 1

1. 1mo male newborn for well-child examination. Uncomplicated pregnancy. Pale skin, fine white hair on the scalp, and blue eyes. Biopsy specimen of the skin will show which findings?
- Decreased number of Melanocytes, Decreased Melanin

2. Study to evaluate effectiveness of cough medication in children. 120 patients under 12 years with URI receive dextromethorphan or no treatment. Parents rate children. Significant improvement in cough scores for patients receiving dextromethorphan. Limitation to internal validity?
- Subjective nature of the survey instrument

3. Newborn at 28 weeks' gestation in severe respiratory distress. Immature alveoli have a diminished ability to serve as sites of effective gas exchange. Increase in which explains this?
- Lung elastic recoil

4. 72yo M with hypertension with severe abdominal pain for 2 hours. Pale and lethargic. P 124/min rr 16, BP 95/60. S4. Abdominal guarding, rigidity, and a pulsatile periumbilical mass. Additional findings?
- Decreased femoral pulses

5. The lymphoproliferative properties of the gammaherpesviruses result in malignant transformation of cells. Epstein-Barr virus is associated with which disease?
- Nasopharyngeal carcinoma

6. 17yo boy with chronic renal insufficiency undergoes unilateral nephrectomy. Kidney is shown. Pathologic process?
- Hydronephrosis

7. 55yo F with 3-day history of persistent right shoulder pain. Began weight-training program 6 weeks ago. Point tenderness lateral to acromion, over the humeral head. Pain with resisted abduction of the shoulder when the shoulder is abducted 90 degrees and the arm is giving the "thumbs down" sign. Tendon injured?
- Supraspinatus

8. 65yo F follow-up after DEXA scan showed a decrease in bone density. Physical normal. Which sets of findings in the bone most likely?
- Osteoblast Activity DECREASED, Osteoclast Activity INCREASED, RANKL Concentration INCREASED

9. 45yo M follow-up after treatment with hydrochlorothiazide for hypertension. Feels faint, light-headed, and dizze when he gets out of bed. P 75/min, rr 12/min, BP 130/85 supine. Changes in the cardiovascular system when going supine to standing?
- Venous Return DECREASE, Carotid Sinus Baroreceptor Activity INCREASE, Cerebral Blood Flow DECREASE

10. 25yo F with palpitations and insomnia for 5 months; she also had 5-kg weight loss. P 125/min. Exopthalmos, thyromegaly, and hand tremors. Thyroid-stimulating hormone concentration less than 0.1, thyroxine (T4) 18, triiodothyronine (T3) 250. Symptoms cause by hormones acting on which receptors?
- Nuclear/retinoid X binding to DNA

11. 3yo girl with abdominal pain, constipation, and irritability for 1 month. Lives in 50-year-old house being renovated. Pallor, normocytic, hypochromic anemia and increased 5-aminolevulinic acid (d-ALA). Lead concentration is 50. Decrased activity of which enzyme?
- ??

12. 72yo M with 3-month history of progressive burning chest discomfort after meals. X-ray of the chest and abdomen show a paraesophageal hernia. Barium swallow shown. Findings present?
- Protrusion of the fundus into the chest above the level of T10

13. 30yo F with 6-month history of intermittent cutaenous flushing and diarrhea. X-ray of the chest shows a solitary pulmonary nodule in the left lower lobe. Increased synthesis of which caused symptoms?
- Serotonin

14. 17yo boy with 4-month history of low back pain and night sweats. 4-kg weight loss. Immigrated to USA from southern India 9 months ago. BMI 18. Tenderness over the L1 spinous process. Dx?
- Tuberculous abscess of the spine

15. 45yo M with chronic renal failure admitted. Unable to convert which toits active form?
- 25-Hydroxycholecalciferol

16. 72yo M with COPD with progressive shortness of breath during the past 3 months. Smoked 1.5 packs of cigarettes daily. BMI 34. P 80min, rr 22, BP 130/80. Pulse oximetry on room air shows oxygen saturation of 94%. Rhonchi heard. Breath sounds decreased bilaterally. Which intervention to slow the rate of decline in pulmonary function?
- Smoking cessation

17. 52yo M 3 days after sudden onset of blindness of the left eye. No eye pain. Funduscopy shows a pale, opaque fundus and a bright red fovea centralis. Visual field shows dense scotoma of the entire visual field of the left eye; right eye normal. 6 months later, patient remains blind in the left eye. If left eye is illuminated, which reaction in the right pupil?
- No constriction because the retinal ganglion cells in the left eye have been destroyed

18. 45yo F (lll,7). Several people in her family, including her son (lV,3), have hereditary telangiectasia. Pedigree shown. Physical exam normal. Which explains the reason for this patient's health?
- Incomplete penetrance

19. Male newborn has multiple congenital anomalies resulting from failure of migration of neural crest cells during embryonic development. Dies 3 weeks later. Autopsy of organs will show?
- Absence of the adrenal medulla

20. 31yo F treated for Plasmodium vivax malaria with primaquine and chloroquine to prevent relapses. Which explains why primaquine is used with chloroquine in this patient?
- Primaquine kills hypnozoites

21. 72yo F with diffuse muscle pain and weakness for 6 months. Exacerbated by activity. Proximal muscle weakness and tenderness over the surface of both shins. Dot on monogram indicates relationship between her serum calcium and parathyroid hormone concentrations. Cause of symptoms?
- Osteomalacia

22. 2mo male with a ventricular septal defect with poor weight gain and a 5-day hx of rapid breathing and difficulty feeding. CHF, and an operation to place a synthetic patch across the septal defect planned. Compared to prior to operation, which heart pressures are most likely 1 month after a successful operation?
- Left ventricular pressure INCREASED, Right ventricular pressure DECREASED, Left atrial pressure DECREASED

23. 54yo F with 2-week history of heavy vaginal bleeding. Menopause 5 years ago. Mastectomy 3 years ago for estrogen receptor-positive breast carcinoma with axillary lymph node involvement. Taking tamoxifen for 3 years. Biopsy of endometrial tissue shows hyperplasia. Explanation?
- The patient's medication has an agonist effect on endometrial estrogen receptors

24. 25yo F with general malaise and a facial rash for 1 week. 10-year history of episodes of pleurisy and arthritic pain in peripheral joints. Malar rash that does not involve the nasolabial folds. Cardiolipin antibody, anti-dsDNA, and anti-Sm antibody assays are positive. Which hematologic abnormalities is most likely?
- Thrombocytopenia

25. 69yo M with benign prostatic hyperplasia develops urinary retension 1 day after undergoing removal of a melanoma. After cath, drug is given that increases phophoionositide turnover in the smooth muscle cells of the bladder fundus but has no effect on nicotinic synpases. Which drug?
- Bethanechol
Click to expand...

myoungren · Jul 31, 2016

#3 is not congenital cytomegalovirus...got that wrong myself!

orthopod said: ↑

Block 4 part 1

1. 27yo M with 3-hour hx of nausea, cramping abdominal pain and diarrhea. Sx started 24 hours after he ate at a wedding reception and other people have similar sx. Culture of stool grows Salmonella enterica. Able to maintain oral hydration. Sx resolve after 36 hours but persist in milder form for several days. Which occurs if pt is treated with antibiotics?
- Prolonged fecal excretion of the organism

2. 28yo African American M with 3-month hx of mild fatigue and weakness, 10-lb weight loss. Also, 6-month hx of dry cough with chest pain and shortness of breath. Pt is a carpenter. He has several pets. Spent a week in Mexico. Smokes 1/2 pack cigarettes for 10 years. His BMI is 22. Mild wheezes heard. CXR shows hilar adenopathy and right paratracheal node enlargement. Biopsy show noncaseating granulomas. Negative acid-fast bacilli and fungi. Strongest predisposing risk factor?
- Ethinicity

3. 2-month-old girl after abnormal complete blood count. Her blood group is A, Rh-positive. Baby born at term to healthy woman whose blood group is O, Rh-positive. Birth weight was 8 lb 0 oz. pregnancy and delivery were uncomplicated. Patient has been active and feeding well. T 99.7 F, HR 120, RR 30. Physical exam normal. Labs:
Age 24 Hours
Hemoglobin (g/dL) (N=1 1-15) 16.9
Hematocrit (%) 51
Leukocyte count (Imm3) (N=5000-19,500) 17,200
Segmented neutrophils 4%
Eosinophils 4%
Basophils 4%
Lymphocytes 69%
Monocytes 19%
Platelet count (Imm 3) (N=150,000—400,000) 185,000

1 Week
Hemoglobin (g/dL) (N=1 1-15) 15.7
Hematocrit (%) 49
Leukocyte count (Imm3) (N=5000-19,500) 15,600
Segmented neutrophils 3%
Eosinophils 4%
Basophils 2%
Lymphocytes 73%
Monocytes 18%
Platelet count (Imm 3) (N=150,000—400,000) 198,000

1 Month
Hemoglobin (g/dL) (N=1 1-15) 12.7
Hematocrit (%) 39
Leukocyte count (Imm3) (N=5000-19,500) 12,900
Segmented neutrophils 5%
Eosinophils 2%
Basophils 1%
Lymphocytes 77%
Monocytes 15%
Platelet count (Imm 3) (N=150,000—400,000) 205,000

- Congenital cytomegalovirus infection (?)

4. 50yo M with progressive left-sided vision loss during past 6 months. On visual field testing, patient cannot see to the left with either eye. Lesion is where in the following drawing?
- D

5. Investigator conducts study of von Hippel-Lindau (VHL) disease. The protein forms part of the ubiquitin-ligase complex (E3) that targets hypoxia-inducible factor-1. Diagram shown. Step IV involves which organelle?
- Proteasome

6. 30yo nulligravid F unable to conceive for 2 years. Has had 80 lb weight gain during this period. Last menstrual period was 4 months ago. Before periods were regular until 25yo. Now they are every 90 to 120 days. Her BMI is 35. BP 130/90. Physical and pelvic normal. Pregnancy test negative. Labs: Prolactin 15, TSH 2, FSH 10, LH 28. Withdrawal bleeding present after progestin challenge. Patient's oligomenorrhea is due to increased production of which hormone?
- Estrogen in the adipose tissue

7. 13yo boy is going to get chemotherapy for leukemia with histological findings of malignant lymphocytes. The neoplastic cells do not express: CD4, CD8, surface IgM, surface IgG, cytoplasmic IgM and u-heavy chain, cytoplasmic IgG, and gamma-heavy chain. The cells express class I MHC and show rearrangement of the T-lymphocyte receptor beta-chain gene D and J segments. What is the normal counterpart of these lymphocytes?
- T-lymphocyte thymocytes localized to the thymic cortex

8. 56yo F with fever and shortness of breath for 2 hours. She has had urinary frequency and dysuria for 2 days. In respiratory distress, T 101.7 F, HR 120, RR 30, bp 80/50. Which causes hypotension?
- Lipopolysaccharide

9. 60yo M generalized weakness for 6 hours. Onset occurred 2 hours after taking 4 (rather than one) of a medication that prevents angina pectoris. HR 36, bp 100/50. After isoproterenol, HR increases to 60. Mechanism of patient's usual chronic medication?
- Reversible, dose-dependent

10. 45yo M with ulcer in anterior superior portion of fundus of stomach comes with acute pain in left upper quadrant and left shoulder for 4 hours. Physical shows rigid abdomen. Perforation of ulcer suspected. Irritation of which explains the left shoulder pain?
- Diaphragm

11. 24yo M with recurrent vesicular lesion on left upper lip. Causal virus maintains latency in which cell?
- Sensory neurons

12. 50yo M with firm thyroid nodule. Neoplasm is resected and histology shows sheets of granular cells embedded in hyaline stroma. Stain shows cytoplasmic calcitonin. Carcinoma type?
- Medullary

13. 70yo M 4-month history of weight loss, abdominal pain, and diarrhea. Stool shows increased excretion of neutral fat and muscle fiber. D-xylose test for carbs shows no abnormalities. Tissue exam of intestinal biopsy is normal. Patient will respond favorably to which agent?
- Pancreatic enzymes

14. 22yo M with left forearm slashed with pocketknife. Bleeding stopped with pressure. HR 110, bp 135/85. 3-cm laceration transversely over palmer aspect of distal forearm and 2 cm proximal to the distal palmar wrist crease. Unable to ABduct left thumb. Sensation decreased over palmar aspect of thumb and index and middle fingers. Injured nerve?
- Median

15. 20yo F with menstrual period 1 week late. Menses were normal and had unprotected sex 20 days ago. Urine pregnancy test positive. Stage of development of embyro now?
- The neural plate is present, but eh neural tube is not yet complete

16. 51yo F gets dilation and curettage for dysfunctional uterine bleeding. During anesthesia, she gets isoflurane and another compound. T 105 F and muscle rigidity is present. Which compound caused adverse effect?
- Succinylcholine

17. 42yo F with multiple sclerosis has double vision that began yesterday morning when she awoke. Only medication is interferon beta. Eyes converge normally, but decreased adduction in both eyes during lateral conjugate gaze. Where is demyelinating plaque that's causing the diplopia?
- Medial longitudinal fasciculus

18. A paper says, "We chose the sample size to have an 80% power of detecting a 15% mean difference with a significant level (two-sided) of 5%." If there is really no difference between the groups overall, what is the chance the study will find a statistically significant difference, and what is this error called?
- 5%, Type I error

19. Study conducted to assess new prenatal test for Down syndrome. What is the specificity of the new test? See chart comparing maternal plasma DNA analysis and amniocentesis or postnatal examination.
- 99%

20. Newborn undergoes surgical repair of esophageal atresia. Pathological exam shows esophagus that's fibrotic and has no lumen. Which of the following embryonic germ layers is the origin of the cells that fill the lumen?
- Endoderm

21. 1yo boy with 4-week hx of progressive generalized tonic-clonic seizures and a strange odor in urine. Hx of delayed development. Physical shows fair skin and blond hair. Phenylalanine hydroxylase is homozygous for point mutation in intron 12 of affected gene causes skipping of exon 12. Reason for exon skipping in this patient's affected gene?
- RNA splice error

22. 43yo F 40 minutes after a transient hypoxic-ischemic event caused by ventricular fibrillation. Stabilized after using an automated external defibrillator. 2 days later she is unable to remember new events in her life. No other neuro issues. Which part of brain was injured?
- Hippocampus

23. 18yo is a defensive end on football team and wrestler. Patient is embarrassed because of enlarged breasts. He is muscular with no obesity. BMI 29. Sexual development is Tanner stage 5. Physical shows 2-cm soft mounds of breast tissue under areola. Best next step?
- Inquiry about a history of anabolic steroid use

24. 21yo M with self-inflicted laceration to his right arm after he was arrested for trying to rob a convenience store. He has hx of arrests for substance abuse, robbery and assault. Was in juvenile detention center as teen. Threatened mother with knife. Fired from jobs for not complying with employer's policies. Said that jobs were beneath his ability. Personality disorder?
- Antisocial

25. 17yo girl with renal disease undergoes dialysis and is awaiting kidney transplantation. She is often angry and occasionally misses dialysis appointments. Which action will improver cooperation?
- Provide more time to talk with the physician
Click to expand...

myoungren · Jul 31, 2016

Unfortunately #42 isn't storage of these enzymes within the cytoplasm...got that one wrong

orthopod said: ↑

Block 3 part 2

26. 55yo M with 2-month hx of increasing difficulty swallowing and regurgitation of undigested food. Also has noticed unusual rumbling sounds in his voice that originate in his neck. Physical: halitosis. Videofluoroscopic swallowing study shows 4-cm, posterior midline pouch protruding between the thyropharyngeus and cricopharyngeus portions of the inferior pharyngeal constrictor muscle. These muscles are innervated by which nerves?
- Parasympathetic fibers from the vagus nerve

27. Influenza virus strains are characterized by sensitivity to growth inhibition by weak base ammonium chloride (AC). Influenza A San Francisco (SF) virus yields AC-treated cells that approximate those in untreated cells, whereas New York (NY) grows poorly in AC-treated cells. To identify viral genes that segregate the differences in sensitivities of these strains to AC, reassortant viruses are isolated by coinfecting cells with both virus strains. The ratios of growth of reassortant viruses in the presence and absence of AC are shown in table.
- NA (?)

28. 45yo F with pneumococcal pneumonia and bacteremia. Intubated and mechanically ventilated. Temp 39.4 C (102.9 F), pulse 120, bp 90/50. Bilateral crackles heard. Labs: Hemoglobin 13, hct 40%, leukocyte count 500, platelet 250,000. Which protein is necessary for leukocyte count to increase?
- Granulocyte colony-stimulating factor

29. 45yo M has not been to physician in 30 years because he hasn't felt ill. Cardiac exam shows grade 2/6, holosystolic murmur best heard at left axillary line. Which is cause of findings?
- Mitral regurgitation

30. 22yo F HIV positive after sexual contact. Combination therapy with lamivudine (3TC), ritonavir/lopinavir, and zidovudine (AZT) started. Three months later, HIV strain resistant to ritonavir/lopinavir. Resistance came from mutation in a gene critical for which viral processes?
- Protein processing

31. 56yo F has a 3-week hx of progressive difficulty swallowing. Felt large pieces of food wouldn't pass, but now having difficulty with all food and some liquids. pHysical is normal. X-ray after barium swallow shows irregular mass at gastroesophageal junction. Photo shown of biopsy of specimen from esophagogastroduodenoscopy. Chronic infection with which pathogen caused histo findings?
- Helicobacter pylori

32. 55yo F comes for routine exam. Last menstrual period 8 years ago. No medications and physical is normal. Serum lipid studies ordered to screen for cardiovascular disease. Compared with 25yo F, which is likely to be decreased in patient?
- Serum HDL-cholesterol concentration

33. 50yo F with progressive shortness of breath during past 2 years. RR 20/min. Physical shows cyanosis and ankle edema. Pulmonary artery pressure, pulmonary vascular resistance, and right atrial pressure all increased; pulmonary capillary wedge pressure 9.3 (N=8-16). Ventilation improves with nitric oxide administration. Treatment with bosentan. Drug antagonizes which mediator of pulmonary resistance?
- Endothelin

34. 32yo F comes for follow-up for atypical cells on Pap smear. Physical shows 1X1-cm leukoplakia on cervix. Biopsy shows invasive squamous cell carcinoma. Malignant cell from site will drain to which lymph nodes first?
- Internal iliac

35. 67yo M with 2-day hx double vision and drooping of left eyelid. He has no trauma to that eye. Vitals normal. Physical shows ptosis of left eyelid, eye fixed in the out position and pupil is dilated. Cause?
- Aneurysm of the posterior communicating artery

36. After a stoke, 68yo M has language problem. Speech is fluent but has many grammatical errors, word substitutions, and neologisms. Unable to repeat words and unable to comprehend verbal requests. Which site labeled in picture of brain is damaged?
- J

37. 16yo girl has vaginal itching for 5 days. Requests parents not be told about appointment. Has unprotected sex and asks for oral contraceptives. Labs show gram-negative diplococci. Next step?
- Discuss with her the need for testing her for other sexually transmitted diseases

38. 32yo man has no hobbies. He works as a computer programmer because he can live at home with 15 cats. He says, "I like to be with my cats because they are my best friends. I don't have to waste any time talking to anyone." Supervisor says, "We could use him on some team projects, but he refuses." Dx?
- Schizoid personality disorder

39. 47yo M with myocardial infarction. Pulse oximetry on 30% oxygen shows saturation greater than 95%. Three hours later patient gets shortness of breath. Pulse oximetry shows oxygen saturation of 90%. Crackles heard at lung bases with grade 2/6 systolic murmur. ABG on 30% O2: pH 7.41, pCO2 36, pO2 60. What is the cause of patient's hypoxemia?
- Increased pulmonary capillary pressure

40. 75yo M with COPD and 6 hours acute exacerbation. Intubated and ventilated and treated with corticosteroids. Five day later, T 38.3 C (100.9 F). Leukocyte coute 15,000 (90% neutrophils). Gram stain of sputum shows gram-negative rods. CXR shows new patchy right lower lobe infiltrate. Which endogenous chemoattractants primarily caused recruitment of leukocytes to site of acute inflammation?
- C5a

41. 30yo W seasonal rhinitis on chlorpheniramine for 4 weeks. Adverse effect most likely?
- Drowsiness

42. 3yo girl with 1-year hx short stature. No major medical illness. Below 3rd percentile for height and 10th percentile for weight. Physical shows course facial features and contractures of large joints. Xrays show dysostosis multiplex. Lysosomal enzymes analysis shows increased beta-hexosaminidase, beta-glucuronidase, beta-galactosidase, and alpha-fucosidase activities. Cause of lysosomal enzymes findings?
- Storage of these enzymes within the cytoplasm

43. 25yo primigravid at 12 weeks' gestation 1 hour after passing small amount tissue vaginally. Gross tissue exam shows fetus. D&C shows chorionic villi with focal edema and trophoblastic proliferation. Dx
- Partial hydatidiform mole

44. 30yo M 1-day hx irrational behavior and severe abdominal pain. 3 days ago started tx for UTI with trimethoprim-sulfamethoxazole. Urine light burgundy color during similar time 1 yr ago. Mother and maternal grandfather have sx. Anxious and restless, pulse 96. Physical shows diaphoresis. Serum shows increased 5-aminolevulinic acid (gamma-ALA) and porphobilinogen. Decreased activity which enzyme?
- Porphobilinogen deaminase

45. Studying age of undergoing first colonoscopy. Ages: 50, 50, 50, 51, 52, 58, 65, 65, 75, 84. Mean of 10 patients?
- 60 years

46. 35yo G1P1, 2-month history of generalized weakness and fatigability exacerbated by exercise. Sx began during pregnancy. Physical shows diplopia. Reduction in muscle strength with repetitive movement, but preservation of deep tendon reflexes. Pyridostigmine provides relief. Antibodies to which protein?
- Nicotinic acetylcholine receptor

47. 4yo boy with respiratory tract colonization with pseudomonas. Sweat chloride is 120 (N<60). Mode of inheritance?
- Autosomal recessive

48. 72yo F with acute myocardial infarction and gets cardiac catheterization. Angiography shows left dominant circulation, 90% narrowing of artery going to diaphragmatic surface and AV node. Stent going to be placed, and catheter must be passed through which vessels to reach narrowed vessel?
- Left coronary, circumflex, posterior interventricular (posterior descending)

49. 27yo F with 6-hour history of high-grade fever, rash, and progressive confusion. Underwent sinus operation for removal of nasal polyps 2 days ago. Difficult to arouse. T 39.2 C (102.5 F), HR 110, RR 18, bp 86/60. Physical shows diffuse rash with erythroderma and hyperemic oral mucous membranes. Liver edge palpable. Removal of surgical packing in nares shows erythematous mucosa. Labs: hb 11.5, hct 34.5%, leukocyte count 13,000 (80% neutrophils), platelets 88,000, Creatinine 2.2, AST 55, ALT 60. Gram statin nasal swab: gram-positive cocci in cluster. Mechanism of causal organism?
- Superantigen activation of T lymphocytes

50. 43yo M with 10-year history alcoholism comes for changes in skin color. Patient taking acetaminophen for 3 days for severe headache. Physical: jaundice. Labs show increased prothrombin time and increased serum AST activity. Alternation in which metabolite in hepatocytes is a/w his illness?
- Decreased glutathione
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orthopod · Aug 3, 2016

@myoungren Sorry for the late reply! Hopefully you got it figured out by now, but I'll take a look over the next few days and confirm the answers. Let me know if you were able to find any other incorrects so I can adjust those as well.

turtle15 · Oct 27, 2016

orthopod said: ↑

Block 2 part 2
26. 4 yo boy with asthma, 4-hour history of difficulty breathing. No improvement with inhaled beta-adrenergic agonist. Exam shows tachypnea and intercostal and subcostal retractions. Expiratory wheezing is heard bilaterally. Following IV methylprednosolone, there is marked clinical improvement. Which molecular pathways of methylprednisolone best explains this improvement?
- Binding to its cytoplasmic receptor, translocation to the nucleus, and activation of transcription of target genes

27. Previously healthy 35-year-old woman develops hypoxemia 35 minutes after ingesting a near-lethal dose of barbiturates. Has not aspirated. Which sets of arterial blood gas values is most likely in this patient?
- Po2: 50; PCo2: 80; (A-a)O2: 10

28. 19-year-old F for a follow-up examination. Has scarring acne vulgaris not been responsive to topical medication. A bacteriostatic drug that acts by inhibiting the binding of aminoacyl-tRNA to the 30S subunit of bacterial ribosomes is prescribed. This drug is which?
- Doxycycline

29. 23-year-old F with 3-day hx of a drooping right eyelid. Also has a 2-week history of visual discomfort when in a room with bright lights. On examination, the right pupil is larger than the left, it also seems like the right eye is looking somewhat down and to the right. These suggest dysfunction to which structures?
- Oculomotor nerve

30. 15-year-old boy with right wrist pain that began when he landed on his hands after falling backward while skateboarding 4 hours ago. No bone deformities of the wrist. Point tenderness to palpation of the radial aspect of the wrist between the abductor pollicis longus and extensor pollicis brevis tendons. Increased risk for which sequelae?
- Avascular necrosis of the proximal aspect of the scaphoid bone

31. A 75-year-old woman with 1-day history of fever and back pain. Her temperature is 39.5°C (103.1°F), pulse is 111/min, respirations are 32/min, and blood pressure is 115/79 mm Hg. Left-sided costovertebral angle tenderness. Labs show leukocyte count of 17,000/mm3 (with 9% bands) and pyuria. Urine cultures grow Escherichia coli. It is determined that the patient's fever is partially due to interleukin-6 (IL-6), which was induced by the IL-1 produced during the immune response. Which of the following best describes the role of IκB in the nuclear factor-kappa B (NF-κB) signal transduction pathway from IL-1 binding to IL-6 induction in this patient?
- Releases NF-kB after undergoing phosphorylation

32. During an experiment of muscle contraction, intracellular calcium is decreased after a substance is administered to a muscle preparation obtained from an experiment animal. Which best explains why contraction is inhibited in this case?
- Myosin binding sites on actin remain covered by troponin C

33. 21-year-old-woman at 30 weeks' gestation is admitted to the hospital because of contractions for 1 hour. Fetal ultrasonography shows that the ductus arteriosus has closed. Inhibition of which enzymes is the cause of this finding?
- Cyclooxygenase

34. An investigator is designing a study to compare a new behavioral program for attention-deficit/hyperactivity disorder (ADHD) with the standard behavioral modification program for this disorder. Because ADHD is more common among boys, girls and boys are randomized into the two treatment groups separately. Which treatment allocation used?
- Stratification

35. One-half hour after an uncomplicated vaginal delivery, a 30-year-old woman delivers the placenta but has continued heavy blood loss from the vagina. Pulse 120/min, BP 90/60. No cervical or perineal lacerations. Uterus is soft, and contractions have stopped. Medical treatment with which is likely to be most helpful?
- Oxytocin

36. 36-year-old man who is heterozygous for an LDL-receptor deficiency has a total serum cholesterol concentration of 330 mg/dL. After taking a drug that inhibits cholesterol synthesis, total serum cholesterol concentration decreases to 200. Which proteins would be upregulated as a result of drug therapy?
- LDL receptor

37. 23-year-old woman comes to the physician because of a 3-week history of frequent thirst and urination; she also has had a 3-kg weight loss during this period. Physical examination shows dehydration and tachypnea. Serum studies show a glucose concentration of 330, 2+ ketones, and a pH of 7.2. Following intravenous fluids and insulin, there is marked improvement. Activity of which enzymes has most likely increased in this patient's hepatocytes?
- Glucokinase

38. 7-year-old boy is brought to the physician because of a 1-day history of fever, headache, nonproductive cough, and muscle aches. T 39.4. Physical shows a mildly erythematous pharynx. Rapid antigen test of nasal secretions is positive for influenza A virus. Treatment with zanamivir is initiated. Which viral activities will be directly inhibited?
- Virion release

39. 65-year-old man with a history of ischemic heart disease comes to the physician because of fatigue and pain and swelling in his legs. BP 135/80 and pulse is 80/min. End-systolic volume is 80 mL and end-diastolic volume is 120 mL. Which represents the ejection fraction?
- 33%

40. 23-year-old man has a 3-month history of mildly depressed mood, decreased energy, and dry skin. His thyroid gland is not palpably enlarged. Thyroxine (T4) and thyroid-stimulating hormone concentrations are decreased. Diagnosis?
- Secondary hypothyroidism

41. 6-year-old girl develops edema, hypertension, hematuria, and proteinuria 2 weeks after an episode of pharyngitis. Diagnosis of acute glomerulonephritis is made. Throat cultures grow catalase-negative, gram-positive cocci. Causal organism?
- Strepyococcus pyogenes (group A)

42. 24-year-old woman is admitted to the hospital because of acute pain in the left lower quadrant of the abdomen. She has leukocytosis and an increased human chorionic gonadotropin concentration. Photograph of the surgically removed specimen is shown. Dx?
- Ectopic pregnancy

43. 3 year old girl with a 2 week history of diarrhea. Her temperature is 37.6 C , pulse is 70/min, respirations are 18/min and BP is 110/70. Physical exam shows generalized lymphadenopathy. a ct scan of the chest and abdomen shows enlarged LNs in the mesentery and para-aortic region. Lymph node biopsy specimen shows marked proliferation of histiocytes and numerous segmented neutrophils. Granulomata are absent and special stain shows numerous acid-fast bacilli, which are subsequently identified as Mycobacterium avium intracellulare. Serum studies show normal concentrations of IgA, IgG, IgM, B lympho, T lympho, and CD4+ and CD*+ T lymphocytes. This patient has likely defective function or expression of which of the following protein?
- Interferon-gamma receptor?

44. A 67-year-old man comes to the physician with 2-month history of pain in his feet. The discomfort is more severe in bed at night and is relieved by taking a hot bath. He has type 2 diabetes mellitus treated with glipizide. His pulse is 60/mm, respirations are 1 2/mm, and blood pressure is 130/88 mm Hg. Strength is normal and symmetric in the distal and proximal upper and lower extremities. The Achilles deep tendon reflexes are decreased, and quadriceps deep tendon reflexes are normal. Sensation to pinprick and vibration is decreased from just above the ankles distally. This patient is most likely to describe his pain as which of the following?
- Burning

45. 5-year-old boy 15 minutes after developing hives and shortness of breath and then collapsing. He had been eating peanuts 4 minutes before the onset of symptoms. On arrival, his pulse is 220/min, rr 10/min, and palpable BP is 40. After establishing a patent airway, the most appropriate next step is administration of which?
- Epinephrine

46. 26-year-old woman with 1-day history of severe rectal pain with no bleeding. No medications and does not smoke cigarettes or drink alcohol. Has been sexually active, and she and her partner use condoms inconsistently. Photograph of the rectal area is shown. Dx?
- External hemorrhoid

47. A 4-day-old male newborn who was born at home is brought to the ER b/c of respiratory distress and cyanosis. The mother reports that she found him in his crib not breathing. He began to breath again after she picked him up. Examination shows narrow thorax. His ears have periauricular skin tags. He also has micrognathia, glossoptosis, amandibular cleft, and a short palate. Tracheostomy relives respiratory distresss. Defect such as there are consistent with altered development of which of the following pharyngeal arches?
- First

48. 55-year-old woman with colon cancer and healthy 55yo F participating in study. Malignant cells are obtained from the tumor in the affected patient, and normal colonic epithelial cells are procured from the healthy subject. After both cell types are treated with transforming growth factor-beta, the number of normal cells decreases, whereas the number of tumor cells remains unchanged. The tumor cells most likely express a mutation that inhibits which?
- Apoptosis

49. 8yo boywith moderate mental retardation. Parents say son has recently become more stubborn and has begun to have temper tantrums. Episodes involve fighting about food. Parents concerned he will hurt himself because he picks his skin and pulls his hair when he is frustrated. Father says " He spends his day looking for more things to eat." 10th percentile for height and 90th percentile for weight. Diagnosis?
- Prader-Willi syndrome

50. 48-year-old woman with palpitations. P 180/min BP 104/68. ECG shows atrioventricular (AV) nodal re-entrant tachycardia. Carotid sinus massage is performed and sinus rhythm is restored. Which of the following is the most likely mechanism of the termination of the tachycardia in this patient?
- Increased cardiac parasympathetic activity
Click to expand...

turtle15 · Oct 27, 2016

Can you please explain Block 2 part 2 Q34? Thanks.

HEHE · May 26, 2017

. 2-month old M infant with 2-day hx of generalized tonic-clonic seizures, myoclonus and hiccuping. Fed poorly and floppy. Physical shows decreased deep tendon reflexes and hypotonia. A signally defect in an inhibitory neurotransmitter suspected. Which neurotransmitter?
- Acetylcholine receptor
this answer was showed up in my incorrect answers
I think the correct answer is Glycine receptor (After phenylketonuria, glycine encephalopathy )

HEHE · May 26, 2017

26. 55yo M with 2-month hx of increasing difficulty swallowing and regurgitation of undigested food. Also has noticed unusual rumbling sounds in his voice that originate in his neck. Physical: halitosis. Videofluoroscopic swallowing study shows 4-cm, posterior midline pouch protruding between the thyropharyngeus and cricopharyngeus portions of the inferior pharyngeal constrictor muscle. These muscles are innervated by which nerves?
- Parasympathetic fibers from the vagus nerve
this answer was showed up in my incorrect answers
I think the correct answer is inferior pharyngeal constrictor muscle innervated by motor fiber from vagus nerve

HEHE · May 26, 2017

26. 55yo M with 2-month hx of increasing difficulty swallowing and regurgitation of undigested food. Also has noticed unusual rumbling sounds in his voice that originate in his neck. Physical: halitosis. Videofluoroscopic swallowing study shows 4-cm, posterior midline pouch protruding between the thyropharyngeus and cricopharyngeus portions of the inferior pharyngeal constrictor muscle. These muscles are innervated by which nerves?
- Parasympathetic fibers from the vagus nerve
this answer was showed up in my incorrect answers
I think the correct answer is inferior pharyngeal constrictor muscle innervated by motor fiber from vagus nerve

HEHE · May 26, 2017

1. 1mo male newborn for well-child examination. Uncomplicated pregnancy. Pale skin, fine white hair on the scalp, and blue eyes. Biopsy specimen of the skin will show which findings?
- Decreased number of Melanocytes, Decreased Melanin
this answer was showed up in my incorrect answers
I think the correct answer is Number of Melanocytes-Normal/ Melanin-decreased

HEHE · May 26, 2017

orthopod said: ↑

21. 72yo F with diffuse muscle pain and weakness for 6 months. Exacerbated by activity. Proximal muscle weakness and tenderness over the surface of both shins. Dot on monogram indicates relationship between her serum calcium and parathyroid hormone concentrations. Cause of symptoms?
- Osteomalacia
Click to expand...

this answer was showed up in my incorrect answers
in Osteomalacia (Vita. D deficiency cause decrease Ca, decrease Po4, increase PTH) but in this question nomogram showed decreased in PTH, decreased in Ca so I think the correct answer is Hypoparathyroidism ? anyone answer it correct ?

orthopod · May 26, 2017

@HEHE
Thanks for your suggestions. Using "think" in your responses makes me wary of how certain you are. Either it showed up in your incorrects (hence, you got it incorrect), or it didn't, and you got it correct. Please provide us with any necessary corrections only if you are 100% sure you got it right. Otherwise, it can confuse others in the TestPirates community. Thanks

HEHE · May 26, 2017

orthopod said: ↑

@HEHE
Thanks for your suggestions. Using "think" in your responses makes me wary of how certain you are. Either it showed up in your incorrects (hence, you got it incorrect), or it didn't, and you got it correct. Please provide us with any necessary corrections only if you are 100% sure you got it right. Otherwise, it can confuse others in the TestPirates community. Thanks
Click to expand...

Hello,
Yes, the answer you gave it showed up in my incorrect and because of that I posted a suggestion to change it and I tried to find the correct answer and when I put I think actually I'm %90 certain of the new answers that I suggested
Thanks for your help by posting, it helps me a lot and saved so much time of searching.
I hope the best for you

dococ91 · Jun 17, 2017

HEHE said: ↑

1. 1mo male newborn for well-child examination. Uncomplicated pregnancy. Pale skin, fine white hair on the scalp, and blue eyes. Biopsy specimen of the skin will show which findings?
- Decreased number of Melanocytes, Decreased Melanin
this answer was showed up in my incorrect answers
I think the correct answer is Number of Melanocytes-Normal/ Melanin-decreased
Click to expand...

this makes sense; the stem seems to be describing occulocutaneous albinism, which is a deficiency in the enzyme tyrosinase- melanocytes would be normal but melanin production is down (tyrosinase converts Dopa to melanin)

KT Young · Jul 4, 2017

Hi! I believe the answer to #11 from block 1 is Porphobilinogen deaminase, as the patient in the vignette appears to be presenting with an acute intermittent porphyria attack after being treated with bactrim. The metabolites upstream of this enzyme also match up with those found in this patient's labs. FA2016 pg 395 has more

Noobs · Jul 7, 2017

2. Study to evaluate effectiveness of cough medication in children. 120 patients under 12 years with URI receive dextromethorphan or no treatment. Parents rate children. Significant improvement in cough scores for patients receiving dextromethorphan. Limitation to internal validity?
- Subjective nature of the survey instrument is WRONG. I just answered this but its not correct. Anyone who knew the answer for this question?

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