NBME CBSE REAL EXAM 2024 TEST BANK/ NBME CBSE
QUESTIONS AND ANSWERS/ NBME CBSE LATEST (usmle step
1) MEDICAL EXAMINATION
38 yo F G2P1 at 38 weeks w/ no fetal movement for 36 hours. fetal heart tones heard
by doppler. next step? - nonstress test to make sure baby is okay
37 yo M 2 mo hx of pain in forearm and little finger of his dominant hand, numbness,
weakness of grip, decreased sensation to light touch at tip of finger worse w/
compression of cubital tunnel. works as a receptionist. what is the most likely site of
nerve injury? - ulnar nerve at the elbow --> ulnar nerve entrapment from elbows on desk
67 yo M w/ 6 mo hx of double vision, slurred speech, difficulty swallowing liquid, worse
at end of day, pernicious anemia, autoimmune thyroiditis, bilateral ptosis, CT scan of
chest is show what is most likely cause of intrathoracic lesion? - thymoma --> pt has MG
and 20% of them get thymoma
67 yo M w/ SOB, 25 lb weight loss, smoker, decreased breath sounds of L, CXR shows
L sided pleural effusion. next step? - thoracocentesis --> look at fluid THEN do CT to
look for mass
45 yo F w/ SOB, CP, dizzy, mild numbness and tingling around lips x2 hrs which occur
when she was crossing a narrow bridge on a donkey and thought she was gonna die.
tachy, tachypneic, nitro does't help. next step? - lorazepam --> panic attack **NOT O2**
67 yo M w/ 3 day hx fever, HA, mechanical aortic valve placement for tx of sequelae of
rheumatic fever, L hemiparesis, babinski sign on L, no nuchal rigidity. pt is at greatest
risk of what complication? - brain abscess --> pt has septic emboli from bacterial
endocarditis = hemiparesis
70 yo M w/ urinary hesitancy and frequency x9 mo, DRE w/ enlarged rubbery prostate
nontender to palpation, UA w/ gram negative rods + leukocytess. dx? - outflow
obstruction of bladder
**prostate infection would have tender & enlarged prostate**
4 week old newborn w/ increased difficulty feeding, poor weight gain, 2/6 holosystolic
murmur, CXR w/ cardiomegaly w/ increased pulmonary vascular markings, EKG w/
ventricular hypertrophy. explaination for absence of murmur on initial exam? - high
pulmonary vascular resistance --> VSD w/ lungs not totally functional at birth so no
blood flowing through pulm system until PDA closed and lowers pulm vascular
resistance
, 72 yo M w/ chronic abdominal pain and HA x4 months, drinks 10 oz of homemade
whiskey daily, forgetful, mild short term memory loss and decreased sensation to
pinprick in lower extremities, ataxia, gouty tophi in L elbow. Hgb low w/ low MCV. next
step? - measure blood lead concentration --> pots and pans leak lead into homemade
whiskey --> tx w/ dimercaptol (BAL)
side effect of lithium? - nephrogenic diabetes insipidus
what is wrong in MG? - decreased Ach receptors d/t autoantibodies attacking the
receptors
apocrine vs sebaceous glands? - -apocrine: sweat glands in armpits, the groin, and
nipple --> hidradenitis supprativa
-sebaceous: oil/sebum glands --> acne
47 yo F w/ fatigue. DM2 and FSBG have been 250-350 on several occasions over last
week but before used to be 90-110. fever, orthostatic hypotension, urine dip positive for
glucose but negative for ketones. why does she have orthostatic hypotension? -
intravascular volume depletion --> hyperglycemia leads to polyuria and volume
depletion
16 yo F brought in by mom who request contraception but then mom asks to talk to doc
privately and says her daughter is staying out late, wearing tight clothes and excessive
makeup. father is furious and berates her but mom doesn't tell him most of stuff to
protect daughter. girl says she doesn't know why she does these things but would like to
understand. next step? - family counseling
*not behavioral therapy for pt alone*
4 yo F w/ weight loss, intradermal skin test for PPD, tetanus, candida, and trichophyton
come back negative. leukocyte count normal. nucleic acid hybridization testing of gastric
aspirates shows mycobacterium tuberculosis. what does she have? - t cell dysfxn -->
skin tests need T cells so skin tests were negative but NA was positive
6 month old w/ diaper rash x3 days, 2 cm crusted papular honey-colored lesion w/ clear
discharge in L groin. tx? - mupirocin ointment --> non-diaper associated rash w/ strep
(honey colored) = abx tx
6 yo M w/ cramping abdominal pain and R sided scrotal pain x4 hrs, vomited x1, BS
decreased, R hemiscrotum slightly discolored w/ swelling and tenderness superiorly.
next step? - OR --> testicular torsion = acute event w/ compromised blood supply
acne vulgaris tx? - 1. topical retionids
2. oral or topical antibiotics
3. benzoyl peroxide
4. oral isotretionin (liver toxicity, teratogenic)
