NBME 13 Questions and Answers

26) 65yo man dies after occlusion of LCA. Left ventricle has large irregular area that is soft and pale. Dx?
Coagulation necrosis

27) 19yo woman severe pain to right hip. Refractory IBD with arthritis to hands treated w/ chorticosteriods. Pelvis Xray show collapse of superior half of right femoral head with preservation of articular cartilage. Left hip normal. Dx?
Aseptic necrosis

28) 63 yo woman drooping left eyelid. Intermittent pain in left eye. Large pupil. Husband say wife looking sideways. Eye exam shows ptosis, lateral strabismus, mydriasis of left eye. Brain MRI aneurysm of left PCA. What muscle intact?
Superior Oblique

29) Deceased woman is philanthropist. Designated large sum of money to educate public of leading cause of death in woman. What?
Cardiovascular Disease

30) 1 yo girl multiple bacterial infections since birth. 40% length and weight. White hair, pale skin, blue irises and prominent red pupils. CBC shows neutropenia. Blood smear shows giant granules in neutrophils. MOA?
Defect in phagolysosome function

31) 76 yo woman fever, cough. T101. Treatment with ciprofloxacin. Admitted to hospital due to progressive cough, T102. Sputum culture grew Strep pneumonia. Mutation of gene cause resistance to cipro?
DNA gyrase

32) Experiment model treatment for sickle cell disease involve reactivating gene code for beta chain of fetal hemoglobin. Tx increase affinity of hemoglobin for what?
Oxygen

33) 56 yo man. Cardiac exam show systolic heart murmur best heard at right sternal border 2nd interspace transmitted to carotid arteries. Murmur begins after S1 rises in crescendo before falling in pitch, and ceases before S2. Dx?
Aortic Stenosis

34) 73 yo woman urinary frequency and urgency. Difficulties with walking, conversation, and memory. Neuro exam shows normal strength and sensation. Mini Mental state exam 21/30. Wide base walk, shuffling gait. Head CT shows marketed enlargement of ventricles. DX?
Normal-Pressure hydrocephalus

35) 54 yo man SCC of lung. Germline DNA shows 2 alleles, m and n, at microsatellite locus Z tightly linked to p53 gene. Neoplastic cells shows only m allele. What process?
Loss of heterozygosity

36) female newborn delivered at 34 wks. Dx of persistant pulmonary HTN. Careful monitor for methemoglobinemia, best tx?
Nitric Oxide

37) 60 yo man SOB w/ exertion. 2 younger siblins similar symptoms. Mother dies of dilated cardiomyopathy. Physical exam show jugular venous distention and ankle edema. Hypatomegaly. Inspiratory crackles heard over both lung bases. CXR show cardiomegaly and pulmonary congestion. Angiograph confirm dilated cardiomyopathy. Atrial biopsy show abnormal sacromeres with paracystalline inclusions in mitochondria. mtDNA shows G to A transition. Results added A:T base pari to 3’end of tRNA thus shortening the C loop. What effect on mitochondrial function?
Decreased protein synthesis

38) 25 yo woman w/ OSA, oily, fatty bowel movements since starting drug for weight loss. 11lb wt loss, BMI 27. BP 130/80. Before BP140/85. PHyscial exam normal. Serum lipid study, LDL 250à 150; triglycerides 300 à200. Whats drug?
Orilstat

39) 92 yr man chest pain and SOB. Dx CHF. Diuretic therapy started. Symptoms resolved. Pulse 44, fatigue w/ minimal exertion. Dr say pacemaker. Pt refuse invasive procedures. Dr presents benefits of pacemaker fully, but describes risks and f/u in a cursory manner. What’s violated?
Informed consent

40) 25 yo man pain and burning with urination and frequent urinary urgency. Sexually active w/ several female partners. No condoms. T98, urine protein 2+, culture grow on chocolate agar. Gram stain shows G-neg diplococci. What virulence factors?
Pili

41) 25 yo med student father died of alcoholism and cirrhosis. Med student gets angry at patient with alcoholism. He recognize working with these pts distress him. So he learned how to deal more effectively with these pts. Mechanism?
Suppression

42) 59 yo man 80pack yr develop ulcerated laryngeal neoplasm. Biopsy?
Squamous cell carcinoma

43) 6 wk male newborn persistent nonbilious projectile vomiting. Physical exam show prominent peristalsis. Lab: metabolic alkalosis. MOA?
Hypertrophy of pyloric sphincter

44) 60 yo woman flank pain and pain w/ urination. HTN, recurrent UTI, hypothyroidism. T98, P96, BP152/92. Physical exam normal. Urine 3+blood, 1+leukocytes, few bacteria. U/S show large calculus filling the entire right renal pelvis. Composition?
Struvite

45) Autopsy on 50yo man died of pneumonia. Alcoholism. Sagittal section of cerebellum is show. Whats neurologic exam present?
Gait ataxia.

46) 36 yo man seropositive to HIV nonproductive cough. CXR show diffused interstitial infiltrate. Silver stain of lung biopsy shown. Dx?
Pneumocystis jirovecii

47) 5 yo boy progressive clumsiness and fatigue. Legs are tired. Delivered at term after uncomplicated pregnancy. Met all developmental milestones. Some delay compared with other children his age. Alert. Difficulty rise from chair. Uses arm to push himself into standing position. Unable to jump with both feet together. Physical exam show hypertrophy of calf muscles. Weak hip adduction result dysfunction of muscle inserting on the femur from what location?
Ischium

48) investigator study b2 adrenoreceptors in female animals. During experiment, epinephrine injected IM and effects of b2-adrenoreceptor are observed. What physiologic effects most likely observed?
Uterine relaxation

49) 33 yo woman found mass in her right breast. Exam right breast 2.5cm hard mass in upper outer quadrant. What predicts prognosis?
Lymph node involvement by cells originating in the lesion

50) 95 yo man T102, headache, cough, and muscle aches. Several other residents have similar symptoms. Physical exam shows no other abnormalities. Tx with neuraminidase inhibitor started. MOA?
Release of virus from infected epithelial cells.

 

Hi! Thank you for posting!

I got this question right on my NBME...

"44)32 yo man intermittent flashing spots, blurred vision, vomiting, confusion and difficulty walking. Painter and claims cleaned up spilled bottle of paint thinner. Eye exam show dilated pupils w/ hyperemia of optic disc and retinal edema. Physical show tachypnea. Serums anion gap metabolic acidosis. Meds inhibit what?
Formaldehyde dehydrogenase?"

and the answer is actually Alcohol Dehydrogenase. I guessed, so I'm not sure why it is correct either.

Hope that helps!

 

thanks.

 

BLOCK 2, Q.39.
I dont think BNP is the right answer, it should be ADH
my explanation, he is having ectopic secretion of ADH which causes small cell lung CA. SIADH one of the causes is ectopic ADH secretion. In SIADH urine osm>serum osm which is what is stated in this q.

 

Hi, Mark:
The related possible questions in the answer section are really good, but there are no answers provided, and some of those related questions are equally hard and tricky. Since there is a high chance that the interviewer is going to task those related questions, will you provide answers to them?

 

Hi, Mark:
The related possible questions in the answer section are really good, but there are no answers provided, and some of those related questions are equally hard and tricky. Since there is a high chance that the interviewer is going to task those related questions, will you provide answers to them?

 

Hi, Mark:
The related possible questions in the answer section are really good, but there are no answers provided, and some of those related questions are equally hard and tricky. Since there is a high chance that the interviewer is going to task those related questions, will you provide answers to them?

 

Hi, Mark:
The related possible questions in the answer section are really good, but there are no answers provided, and some of those related questions are equally hard and tricky. Since there is a high chance that the interviewer is going to task those related questions, will you provide answers to them?

 

Hi, Mark:
The related possible questions in the answer section are really good, but there are no answers provided, and some of those related questions are equally hard and tricky. Since there is a high chance that the interviewer is going to task those related questions, will you provide answers to them?

 

Hi, Mark:
The related possible questions in the answer section are really good, but there are no answers provided, and some of those related questions are equally hard and tricky. Since there is a high chance that the interviewer is going to task those related questions, will you provide answers to them?