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NBME 15 Questions and Answers

Discussion in 'USMLE Step 1' started by orthopod, May 24, 2015.

  1. orthopod

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    I will post the questions (in my own words) and answers here in case anyone has a question regarding one. It will take time, so feel free to post any questions here and we can answer them for you. Eventually, we will have a nice list here of all of the questions and answers that you can refer to.
     
  2. orthopod

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    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
    - Has been suggested that the correct answer is: lack of blinding. Will verify and update. Please let me know if you got this answer correct.

    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 DECREASE, 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
     
  3. orthopod

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    Block 1 part 2

    26. 51yo M with a 5-year history of Wegener granulomatosis. Has general malaise, fatigue, myalgia, and arthralgia. Which additional findings is most likely to indicate exacerbation?
    - Hematuria

    27. During normal skeletal muscle twitches, the ATP concentration does not fall appreciably because of which?
    - ATP is quickly regenerated from creatine phosphate

    28. A couple has two children with osteogenesis imperfecta type II (OI). Genetic analysis of the father shows that 1 in 10 of his sperm carry mutations of the type 1 procollagen genes associates with OI. Explanation?
    - Germline mosaicism

    29. 40yo F with breast cancer with 1-week history of progressive loss of peripheral vision to the left in both eyes. Unable to count fingers or detect finger movements on the left. MRI will show a metastatic tumor in which locations?
    - Occipital lobe

    30. 4yo boy with a karytotype of 47,XY+21 develops pancytopenia, lethargy, numerous bruises, pallor, and fever. Subsequent examination of bone marrow will show?
    - Excess lymphoblasts?

    31. 38yo M with progressive heartburn for 6 months. Liquid antacids, at least twice daily, no longer relieve the pain. Modified his diet, decreased his coffee and citrus intake, and has raised the head of his bead. Upper endoscopy shows marked erythema of the distal 6 cm of the esophagus. Three linear erosions are noted. Biopsy show marked inflammation of squamous epithelium. Pharmacotherapy?
    - Omeprazole

    32. 62yo M with productive cough, night sweats, and T to 37.8 during the past 2 weeks. PPD skin test is positive, but culture of the sputum shows only normal flora after 2 days. Biopsy of enlarged lymph node is done. Organisms are most likely present in which cells?
    - Macrophages

    33. Food handler has a fresh furuncle on his face. Prepares meat loaf and lets it sit for 12 hours at room temperature before it is cooked at 350 F for 1 hour. Eight of the 10 people who eat the meat become ill in 4 hours. Symptom most likely?
    - Vomiting

    34. 27yo F with 1mo hx of shortness of breath with exertion and swelling of her legs. P 90/min, rr 22/min, BP 120/80. S3, and a displaced apical pulse. Chest x-ray shows marked cardiomegaly and Kerley B lines. Echocardiography shows ejection fraction of 29%. Dx?
    - Dilated cardiomyopathy

    35. 6yo boy with 3-month hx of pubic and axillary hair growth. Tanner stage 2. Mild enlargement of the testes. If left untreated, which of the following combinations is course of growth in this patient?
    - Height Percentile: 1 year from now 75th, As an adult 25th

    36. 60yo F with 6-month history of pain in her hips and knees. Osteoarthritis, recommends ibuprofen. Patient refuses and asks about using glucosaine. Which responses is most appropriate?
    - "What have you heard about using glucosamine to treat arthritis?"

    37. 18mo boy with severe combined immunodeficiency syndrome requires a blood transfusion for severe anemia. Which blood product is most appropriate?
    - Irradiated packed red blood cells

    38. 66yo F with ovarian cancer in ED for inability to urinate for 2 days and bilateral flank pain for 8 hours. Has not had suprapubic pain. Bilateral costovertebral angle tenderness. Insertion of a Foley catheter yields no urine. Renal ultrasonography shows bilateral hydronephrosis. Which is present?
    - Increased tubular hydrostatic pressure

    39. 60yo F develops a secreting adenoma of the parathyroid gland. Which is increased?
    - Calcium loss from bone

    40. 13yo girl with 5-month history of behavioral problems. Mother states that daughter alternates from being sad and socially withdrawn to being extremely angry and aggressive. Diagnosis of bipolar disorder is made. Treatment with valproic acid, which inhibits histone deacetylase, is started. Drug is most likely to affect which?
    - Transcription

    41. 18yo F with 3-day history of pain with urination and urinary frequency and urgency. Mild tenderness over the suprapubic region. Urine culture grows an organism that is lactose fermenting and spot-indole test positive. Resistant to ampicillin but sensitive to ceftriaxone. Mechanism of antimicrobial resistance exhibited?
    - Beta-lactamase production

    42. 22yo college student with 1-year history of anxiety, irritability, and difficulty sleeping. Feels keyed up and on edge all the time. Worries about school, relationship with her boyfriend. Drinks two cups of coffee each morning and drinks alcohol occasionally. Does not smoke. P 84/min, rr 12/min, BP 110/80. TSH 3, T4 6, cbc wnl. Dx?
    - Generalized anxiety disorder

    43. An investigator is studying Helicobacter Pylori strains isolated from the same patient over several years. The immune response to proteins produced by these strains is observed It is found that the original Helicobacter Pylori from the patient expresses one protein recognized by the patient’s antibodies, but subsequent isolates do not express this protein Sequencing of the gene encoding the protein from the original and subsequent isolates is done It is found that subsequent isolates have nine consecutive cytidine residues, whereas the original isolate has eight The results are shown
    Original isolate:
    ACC CCC CCC ACT CAA AU GA4 CCT AGC
    Thr Pro Pro Thr Gln lie Glu Pro Ser
    Subsequent isolates:
    ACC CCC CCC CAC TCA AAT TGA ACC TAG
    Thr Pro Pro His Ser Asn STOP
    Which of the following mechanisms best explains this genetic change?
    - Slipped-strand mispairing

    44. A 62-year-old man undergoes cystoscopy for investigation and removal of a suspected renal calculus. During the procedure, a cystoscope is inserted through the penis and into the bladder. Slit-like openings are then visualized near the lateral ends of the top of the trigone region of the bladder Which of the following best describes these structures?
    - Ureteric orifices

    45. 70yo F found dead in her bed in a skilled nursing care facility. Had a 12-year history of poorly controlled hypertension. Photograph of her heart at autopsy shown; it weighs 650 g. Which describes the changes?
    - Hypertrophy

    46. Male newborn is delivered at term with a right-sided aortic arch. Physical shows full cheeks, low-set ears, and a small chin. Decreased calcium concentration. Site of the malformations?
    - Third and fourth branchial pouches

    47. 23yo primigravid woman develops fever and chills 2 days after eating unpaseurized cheese. A gram-positive, coccobacillary bacterium is isolated from her blood. Organism?
    - Listeria monocytogenes

    48. 19yo F with painful swelling of the external genitalia for 5 days. Not sexually active. Palpable, tender 3-cm mass in the posterior aspect of the labium majus. Blood and urine cultures are negative. Case?
    - Infection of the greater vestibular (Bartholin) gland

    49. 82yo F with alcohol dependence is admitted to the hospital after sustaining multiple injuries in a fall. Has a recent history of right hip fracture and multiple old and new ecchymoses, abrasions, and superficial lacerations. 3-cm laceration on her forehead, sutured after a fall 6 weeks ago, has dehisced. Has few teeth, hemorrhagic macules around hair follicles on upper/lower extremities. Cause?
    - Inadequate hydroxylation of collagen polypeptides

    50. A study is conducted of patients with restrictive airway disease who have BMIs above normal. Significant correlation (r = -0.25) between body fat and lung capacity. Most accurate conclusion?
    - Increased body fat is associated with lower lung capacity
     
  4. orthopod

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    Block 2 part 1

    1. Which best explains why deoxygenated blood can carry more carbon dioxide for a given Pco2 than oxygenated blood?
    - Deoxyhemoglobin is a better buffer of hydrogen ions than oxyhemoglobin

    2. Healthy 3yo boy has a cleft lip and palate. No other birth defects. Which modes of inheritance is the best explanation?
    - Multifactorial

    3. 18yo F 2-hours after she ingested approximately 100 aspirin tablets in a suicide attempt. Physical shows tachypnea. Two days after admission, her hemoglobin concentration is 12. Test of the stool for occult blood is positive. Which additional hematologic findings is most likely abnormal?
    - Bleeding time

    4. 22yo M in ED 30 minutes after he was hit by an automobile while crossing the street. Struck him on the lateral side of his leg. Unable to dorsiflex the left foot. Inversion and eversion are normal. Which nerve is damaged?
    - Deep fibular (peroneal)

    5. 8yo boy for a well-child examination. His sister died of leukemia 4 months ago. Parents state thta he is sad at times, but he has had only minor performance difficulty at school since his sister died. Patient talks about his sister's death and cries. He then says he has a headache. Which best describes patient's condition?
    - Normal emotional response

    6. An investigator wishes to test the hypothesis that a number of CD44 splice variants correlate with aggressive disease progression and risk of relapse in patients with Hodgkin disease, especially if the variant protein CD44v10 is expressed. The investigator plans to retrospectively screen archives of fresh frozen tissue and paraffin-embedded biopsy specimens from documented Hodgkin disease patients. Assuming the necessary reagents are available, which of the following methods would be the most effective in screening the archives for the variant protein?
    - Immunohistochemistry

    7. A 43-year-old man comes to the physician because of progressive shortness of breath during the past year. He is a stockbroker and has had no environmental exposure to toxins. When asked about his smoking habits, he says he smoked marijuana in college and afterwards, until the age of 28 years. He has not smoked any substance since then. He was adopted as a child and does not know his family history. His respirations are 29/min. Diffuse wheezing is heard on auscultation of the chest. Abdominal examination shows mild hepatomegaly. Pulmonary function tests show a decreased FEV1 and decreased diffusing capacity. A chest x-ray shows hyperinflation consistent with air trapping mostly in the lung bases. A CT scan of the chest is shown. Which of the following is the most likely cause of these findings?
    - Inherited protease deficiency

    8. A 38-year-old homeless man comes to the emergency department because of stomach cramps for 2 hours. He appears drunk and says that he began feeling ill after ingesting a homemade alcoholic beverage provided by a friend. His respiration are 33/min. Physical examination shows no other abnormalities. Fifteen minutes after arrival, he has visual disturbances. Laboratory studies show:
    Serum
    HCO3 - 5mEq/L
    Anion gap 40 mEq/L (N=8-16)
    Osmolality 370 mOsmol/kg H2O
    Arterial blood gas analysis on room air:
    pH 7.10
    Pco2 18 mm Hg
    Po2 120 mm Hg

    A loading dose of an antidote is administered. Which of the following best describes the mechanism of action of the antidote in this patient?
    - Inhibits alcohol dehydrogenase, blocking the conversion of methanol to formaldehyde

    9. 23yo F brought by her roommate abecause she was found unresponsive on the living room floor. Constricted pupils and stupor. Substance responsible?
    - Heroin

    10. 9yo boy has mental retardation and a 4-year history of increasingly frequent major motor seizures. Normal vital signs, clear lungs, a moderate systolic ejection murmur, and discrete pink-to-yellow papules in a butterfly distribution on the bridge of his nose, the malar prominences, and along his nasolabial folds. Ct shows multiple, occasionally calcified nodules on the crests of some gyri in the subependymal regions. Echocardiography shows left ventricular hypertrophy with narrowing of the aortic valvular outflow tract due to a subvalvular mass arising from the septum. Dx?
    - Tuberous sclerosis

    11. 54 M with increasing abdominal pain for the past 2 months and a 9-kg weight loss over the past 3 months. He is jaundiced. CT scan of abdomen shows a mass in the head of the pancreas with considerable extension to the stomach and biliary system. Greatest risk for developing which?
    - Major depressive disorder

    12. 84 F with severe dementia is brought to the clinic by her daughter. Mother frequently refuses to eat despite being provided with her favorite foods. Patient is relaxed and cooperative but unable to provide a reliable history because of her dementia. Has weight loss. Exam shows no acute abnormalities. Daughter appears extremely worried and exhausted and is intermittently tearful during the visit. Which interventions is most appropriate?
    - Discuss the stresses of the patient's care with the daughter and provide information regarding possible assistance

    13. 14 boy has had fatigue, intermittent right lower quadrant abdominal pain, diarrhea, and a 5-kg weight loss over the past 6 months. A diagnosis of inflammatory bowel disease limited ot the terminal ileum is made. Absorption of which is impaired?
    - Vitamin B12 (cobalamin)

    14. 22 basketball player who uses cocaine recreationally suddenly develops severe shortness of breath after a routine scrimmage. Respirations of 25/min. Left lung field is hyperresonant and breath sounds are diminished. Dx?
    - Pneumothorax

    15. A healthy 25-year-old man participates in a study of muscle function. The electrophysiologic observations made on a muscle biopsy specimen are shown. Via iontophoresis, 1 μM acetylcholine (ACh) was applied to the muscle surface. Extracellular Ca2+ concentration was decreased to prevent end-plate potentials from acting as a suprathreshold for muscle action potentials.
    Normal Muscle: epp Amplicude 10; mepp Amplitude 1; Response to Ach 1
    Which electrophysiologic characteristsics is expected in a muscle biopsy specimen from a patient with acute botulism?
    epp Amplitude: epp Amplitude 1; mepp Amplitude 1; Response to Ach 1

    16. 3 year-old boy with chronic otitis media is scheduled to undergo bilateral myringotomies with placement of polyethylene tubes under general anesthesia. Asleep after only three to five breaths. Which properties of the anesthetic is the most likely explanation for the rapid onset of action?
    - Low blood solubility

    17. 56 yo F with 1-hour history of rapid heart rate and shortness of breath. Has 2-month history of palpitations. Weighs 55 kg. ECG shows ventricular tachycardia. Plan to initiate rx with an intravenous bolus dose of an antiarrhythmic agent to attain peak serum concentration of 10 mg/L. Volume of distribution if 1.81 L/kg Appropriate loading dose?
    - 1000

    18. 6 yo boy with severe mental retardation and choreoathetosis is being evaluated Lesch-Nyhan syndrome. Leukocytes are obtained for an assay of hypoxanthine-guanine phosphoribosytltransferase at saturating concentrations of phosphoribosylpyrophosphate and varying concentrations of guanine. Results shown.
    Which is the approximate Michaelis constant (Km) for guanine in this patient?
    - 1.0 to 2.0

    19. 22 yo M with an 8-year history of epsidoes of yellow-tinged eyes. He is a medical student, and says that he has noticed that the symptom occurs during studying for final exams and other periods of stress. No pain. Serum show: Bilirubin, total: 3.2; Bilirubin direct 0.4; Alkaline phosphatase 35, AST 16, ALT 15. Which explains signs?
    - Decreased conjugation of bilirubin

    20. 59 year-old man comes to the physician because of a 10-day history of shortness of breath, fatigue, and cough. Respirations 12/min. Lungs clear to auscultation and percussion. Labs show:
    Hemoglobin 11.8 g/dL
    Hematocrit 36%
    Leukocyte count 146,400/mm3
    Segmented neutrophils 47%
    Bands 12%
    Eosinophils 1%
    Basophils 5%
    Lymphocytes 2%
    Monocytes 2%
    Metamyelocytes 7%
    Myelocytes 18%
    Prornyelocytes 2%
    Other cells 4%
    Platelet count 804,000/mm3
    Which of the following is the most appropriate pharmacotherapy for this patient?
    - Imatinib

    21. 45 yo M has a 2-day history of severe abdominal pain. Patient admits to consuming large amounts of alcohol over the past few days. Serum amylase activity of 700, lipase of 850, and serum calcium concentration of 7. Appropriate therapy is initiated; however, the patient dies after 48 hours. Photomicrograph shows the mesenteric fat as seen at autopsy. Which explains the appearance of the fat?
    - Action of pancreatic enzymes on adipose tissue

    22. 32 yo F with a 6-month history of increased urinary frequency, especially at night, and increased thirst. She tells the physician that she is always thirsty despite frequent water intake. Has bipolar disorder treated with lithium carbonate. Physical normal. Serum sodium concentration is 154 meq/L, and urine osmolality is 180 mosm/kg. Abnormal function of which is the most likely explanation?
    - Collecting duct

    23. Vision screening is performed on 4000 people who are older than 65 years. Cataracts are found in 200. Which best describes the annual incidence of cataracts in this population?
    - Unable to calculate due to insufficient data

    24. 28 year-old woman has hirsutism and irregular menstrual periods. Which is the most likely underlying abnormality?
    - Polycystic ovarian disease

    25. 34 year-old woman who is a scientist brought to ED after being exposed to aerosolized 123-I while synthesizing a radiolabeled compound. Reports no symptoms other than anxiety. No allergies. Most appropriate initial treatment is?
    - Potassium iodide
     
  5. orthopod

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    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
     
  6. orthopod

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    #6 orthopod, Feb 10, 2016
    Last edited by a moderator: Mar 1, 2016
    Block 3 part 1

    1. 48yo M with 1-hour history of nausea and chest pain radiates to left arm. ECG and cardiac enzyme confirm myocardial infarction of anterior wall. 14 hours after he is in cardiac arrest. Resuscitation efforts are successful after 30 minutes. Immediately develops severe oliguria. Studies show increased urea nitrogen and creatinine. Patient's urine microscopically shows?
    - Degenerating epithelial cells and dirty brown granular casts

    2. 4yo boy with 2-month progressive weakness and loss of muscle function. Difficulty running, climbing stairs, rising from sitting position. Hypertrophy of calf muscles on physical. Markedly increased creatine kinase activity. Cause of defective or absent protein in which areas of muscle?
    - Cytoskeleton

    3. 75yo M with cerebral infarction. Dies 1 week later. Exam of brain shows which type of necrosis?
    - Liquefaction

    4. 43yo F with 6-month hx of altered consciousness. During hx, she stops talking mid-sentence turns her head to right, and extends and stiffens right upper extremity. Has blank look and doesn't respond to questions. Then has repetitive lip smacking and picking movements of hands. 30 seconds long. Returns to normal state in 4 to 5 minutes. Type of seizure?
    - Complex partial

    5. 64yo M with 2-month history of progressive shortness of breath with minimal activity. Temp 37 C (98.6 F), RR 30, BP 125/80. Physical shows clubbing of fingers. Total lung capacity is decreased. Chest Xray: coarse reticular pattern. Underlying cause of findings?
    - Increased fibrosis in interstitium

    6. 25yo F with hx of rheumatic fever and mitral valve dysfunction has 2-week hx of fever and fatigue. Had a root canal 1 month ago, before which she took single dose amoxicillin. Temp 38.4 C (101.2 F). 4/6 blowing murmur heard at left axilla. Gram stain from blood culture shown. Blood agar plates shows alpha hemolysis. Organism?
    - Streptococcus mitis

    7. 3yo girl 1-month hx of lump on upper neck. Physical shows 2-cm mass midline. Mass moves upward with swallowing and protrusion of tongue. Radionucleotide imaging with technetium 99m pertechnetate shows uptake in mass. Biopsy of mass shows?
    - Follicular cells (thyroglossal cyst)

    8. 48yo F 2-month hx pain and stiffness in hands, elbows, knees, hips when she gets out of bed in morning. Physical shows multiple swollen, tender joints. Presence of which would best support dx of rheumatoid arthritis?
    - Autoantibody (IgM) reactive with IgG

    9. 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

    10. 53yo M with fever and hypotension treated at hospital for crush injury to right lower extremity. Leg infected. During surgical debridement, myonecrosis found. Gram stain shows large gram positive rods with few neutrophils. Organism?
    - Clostridium perfringens

    11. 39yo F with 25-year hx of multiple symptoms including band-like headaches, blurred vision, pain in neck, back, arms, legs, nausea, irregular bowel movements, urinary urgency, difficulty orgasm, excessive menstrual bleeding. Multiple physicians since teenager, many diagnostic tests, multiple hospital admissions, no abnormalities found. Best statement?
    - "I'd like to assess the symptom causing you the most distress and schedule monthly follow-up appointments."

    12. Study began in 1950s to research causes of lung cancer. 40,000 physicians asked if they smoked cigarettes. The frequency of lung cancer was then assessed 10 years later, and the group of smokers and nonsmokers were compared. Study design?
    - Cohort Study

    13. 26yo F with flank pain, palpitations, sweating and recurrent headaches past 2 weeks. BP is 180/95. Urine shows increased concentrations of metanephrine. CT abdomen shows retroperitoneal mass. Mass is from which region labeled in picture?
    - E (adrenal medulla)

    14. Four days after a hike in forest, 40yo M develops multiple intensely pruritic areas on skin (photograph). The involved skin was not covered by clothing. 1% hydrocortisone obtains relief. Lesions subside in 1 to 2 weeks. Findings consistent with which condition?
    - Delayed (type IV) hypersensitivity reaction

    15. 52yo F with no history of major illness. Vitals are normal. Physical is normal. Labs: hemoglobin 10.2, hematocrit 31%, mean corpuscular volume 65, leukocyte count 5900, platelet count 350,000. Dx?
    - beta-Thalassemia minor

    16. 20yo cyclist taking recombinant human erythropoietin has polycythemia. Cause?
    - Proliferation of erythroid precursors

    17. 26yo M has loose, foul-smelling stools that float. Histology of biopsy of proximal small intestine indicates loss of villi (flat mucosa). Dx?
    - Celiac disease

    18. A 28yo F has severe lethargy for 2 hours. T 98.7 F, pulse 110, RR 24, bp 126/78. Physical shows obtundation. Glucose 25. She receives 50% dextrose in water. She doesn't have type 1 or 2 diabetes and takes no medications. Glucose concentrations within normal ranges and 2-hour glucose tolerance test is normal. Insulin concentration are within range. Six hours later she is unresponsive, glucose is 32. Suspect surreptitious insulin use. Best next step?
    - Determine the c-peptide concentration in the latest blood specimen drawn.

    19. 37yo F found unconscious. Temp 36 C (96.8 F), pulse 128, bp 70/40. Physical shows cool, pale extremities, JVD, faint peripheral pulses, crackles bottom 2/3 of lung fields. Heart sounds normal with no murmurs. Withdraws to painful stimuli. Which type of shock?
    - Cardiogenic shock

    20. 25yo primigravid F 25 weeks' gestation uses cocaine one to two times weekly. Vitals normal. Physical: uterus consistent with 25-week gestation. Ultrasound shows no abnormalities. Fetus increased risk of what because of her cocaine use?
    - Prematurity

    21. 32yo M 3-month hx episodic epigastric cramping that awakens him at night and is relieved by eating. Smoker 1 pack per day and 3 cups of coffee daily. Serological testing shows helicobacter pylori for which he gets antibiotics. Which lifestyle change will decrease recurrence of symptoms?
    - Decrease smoking

    22. 71yo F with 30-year hx of type 2 diabetes treated with insulin. She has BMI 23. Her bp is 116/78. The patient most likely has endogenous fasting serum insulin concentration (N=5-20 uU/mL) closest to which?
    - 1 uU/mL

    23. 24yo F with Marfan syndrome has home pregnancy test that was positive 1 week ago. Previous evaluations showed mild coarctation of the thoracic aorta with dilation of ascending aorta, mild aortic regurgitation but no heart failure. If pregnancy were to proceed, what is the mechanism would most likely increase the amount of aortic regurgitation in this patient?
    - Hypervolemia

    24. 6yo girl has been receiving treatment with potassium citrate monohydrate since dx with renal tubular acidosis at age 2yo. Physical exam is within normal limits. Na 142, K 3.5, Cl 115, HCO3 18, BUN 9, Creatinine 0.9. A defect in renal ammoniagenesis suspected. Which substrate is source of ammonia production?
    - Glutamine (?)

    25. 2yo girl brought in 20 minutes after ingesting insecticide. She is in moderate respiratory distress. Respirations are 18/min and shallow. Pulse oximetry on room air shows oxygen saturation of 82%. Physical shows copious oral secretions. In addition to securing airway, best next step is giving which medication?
    - Atropine
     
  7. orthopod

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    #7 orthopod, Feb 10, 2016
    Last edited by a moderator: Mar 12, 2016
    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.
    - HA

    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?
    - H (Wernicke's)

    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
    - Has been suggested that the answer is: abnormal targeting into lysosomes (I-cell disease). Will verify and update.

    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
     
  8. orthopod

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    #8 orthopod, Feb 10, 2016
    Last edited by a moderator: Mar 15, 2016
    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 neutropenia

    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
     
  9. orthopod

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    #9 orthopod, Feb 10, 2016
    Last edited by a moderator: Mar 15, 2016
    Block 4 part 2

    26. 7-month-old girl with HR 110, RR 22, BP 95/50. Cardiac exam shows 3/6 systolic murmur best heard at interscapular region. Femoral pulses are decreased bilaterally. Dx?
    - Coarctation of the aorta

    27. 2-month-old boy with hypotonia and poor feeding since birth. Physical shows large fontanels, midface hypoplasia, hepatomegaly and cryptorchidism. Serum show increased very-long-chain fatty acids, phytanic acid, and pipecolic acid. If hepatocytes were analyzed, which organelle absence?
    - Peroxisomes

    28. 30yo F with Hodgkin disease dx 10 years ago and treated with radiation and chemo for 6-month period. Remained in remission for 10 years. Now feels weak and has petechiae and ecchymoses. Dx with acute myelogenous leukemia. Course of events?
    - Therapy for Hodgkin disease causes mutations in hematopoietic stem cells, and one mutant cell progresses to leukemia

    29. 75yo F with 3-month hx of enlarging lesion on her face. Physical shows 1.5-cm, brown-black, mottled, scaly lesion with irregular borders. Microscopic exam of biopsy shows atypical melanocytes along basilar layer of epidermis. Cause?
    - Lentigo maligna

    30. 65yo M with hypertension volunteers for new loop diuretic therapy trial. Acid-base/volume status monitored. After 3 days of tx, which sets of findings is likely?
    - Metabolic alkalosis (acid-base), yes (volume contraction)

    31. 23yo nulligravid F is unable to conceive for 1 year. Physical and pelvic are normal. Hysterosalpingograms shown. Dx?
    - Blockage of both fallopian tubes

    32. 18yo M with 1-year hx of progressive headaches. Xray of head shows cystic tumor above the sella turcica. Serum concentration of which hormone is increased?
    - Prolactin

    33. 26yo F with vaginal irritation and discharge for 5 days. Sexually active with same partner for 6 months. Uses a diaphragm for contraception and partner sometimes uses condom. Frothy, yellow-green discharge in vagina. Vaginal wall is markedly erythematous and two red macular lesions on cervix. pH is 4. No foul or fishy odor. Micro exam shows motile organisms with flagella. Tx?
    - Oral metronidazole

    34. 5yo boy stung by bee. 30 minutes there is local edematous area. Extravascular accumulation of fluid is directly related to which?
    - Gap formation between endothelial cells

    35. 71yo F with sudden onset double vision. 4-day hx of progressive fever, fatigue, headache, left-sided facial pain, periodic episodes of blurred vision. T 101 F. Physical shows swelling and tenderness of left side of face. Labs show mild normochromic anemia and ESR 60. Dx?
    - Temporal arteritis

    36. 50yo M with 2-week hx of progressive shortness of breath while climbing stairs. Father had major myocardial infarction at 52y. HR 110 and regular, RR 16, bp 135/95. Lungs clear. Heart sounds normal with physiologic split S2. Stress echocardiography shows hypokinesis of posterior left ventricle with increasing activity levels. Cause?
    - Stenosis of the right coronary artery

    37.
     
  10. kingme

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    1. is wrong, should be same number of melanocytes with decreased melanin.
    11. I think was ferrochelatase.
    I thought there was something else wrong, but I forgot where it was.

    Thanks for uploading these!
     
  11. Francisco J Sandoval

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  12. Francisco J Sandoval

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    question 9 about, venous retur, carotid sinus and cerebral flow... all decrease...
     
  13. Francisco J Sandoval

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  14. kingme

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    Yes, this was it. It is correct as Francisco says.
     
  15. orthopod

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    Thank you for the corrections. I will verify these and make the appropriate adjustments.
     
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  16. KAndrea

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    #16 KAndrea, May 27, 2016
    Last edited: May 27, 2016
    I'm pretty sure Block 2 #18: should be 0.2-0.5
    Block 3: #7 is follicular cells (thyroglossal cyst)
    #27 is HA
    #36 is H (wernicke's is posterior temporal lobe)
    #42 is abnormal targeting into lysosomes (I-cell disease)

    Block 4 #3- congenital neutropenia
     
  17. orthopod

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    @KAndrea thanks for the suggestions. I'll veridy these and make any necessary adjustments!
     
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  18. KAndrea

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    Sounds good!!! =) Thanks for taking the time to do all of this!! Much appreciated!
     
  19. Kevin

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    Block 1 # 2 - lack of blinding between groups
     
  20. Mohammad Taha

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    Hey Orthopod
    Would you please send me the NBME form 15 which you made the above listed questions and answers from? Because the order of the questions is different from one to one and it takes time to find out which the question you are looking for!
    Hz9912@gmail.com
    Thanks a lot!
     
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