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NBE CBSE 5 REAL EXAM BLOCK 1 T0 5 WITH 165 QUESTIONS AND CORRECT ANSWERS. GURANTEED A+
Block 1
1. A 3−month old infant with DiGeorge syndrome is brought to the office by his mother 1 week after a 2−week hospitalization
for treatment of an abscess at a previous intravenous site. This was the patient’s second serious infection requiring
admission to the hospital, and his mother thinks that he is getting sick again. She says his temperature this morning was
38.5C (101.3F) and he has not shown interest in feeding today. He was born at term. Physical examination at birth showed
a cleft palate. Echocardiography obtained at birth disclosed a right−sided aortic arch. The infant is 50cm (20 in; 10th
percentile) long and weighs 4593 g (10 lb 2 oz; 3rd percentile); head circumference is 38 cm (15 in; 3rd percentile). Vital
signs now are temperature 38.0C (100.4F), pulse140/min, respirations 28/min, and blood pressure 92/58 mm Hg. Physical
examination discloses a tender area of induration with erythema on the right foot. You suspect the infant has a cellulitis
and arrange for admission to the hospital. Which of the following is the most likely cause of his recurrent infections?
A. Congenital heart defect
B. Hypogammaglobulinemia
C. Insufficiently treated prior infection
D. Malnutrition
E. T−lymphocyte deficiency
2. A 15−year−old boy is brought to the office by his mother 1 hour after having an episode of weakness and numbness of all
extremities, loss of vision, and syncope. The episode lasted 10 minutes, after which he regained consciousness and was
normal. Two weeks ago he had a surfing accident, during which he struck his head and neck on the surfboard. He did not
seek medical attention at the time. On questioning now in the office, he says that since the accident he has had
intermittent episodes of vertigo that have lasted 5 minutes each. Vital signs are normal. Physical examination discloses no
abnormalities. Which of the following are most appropriate next step in evaluation?
A. EEG
B. Emergent MRI/MRA of the brain and cervical spine
C. C. Observation at home
D. Observation in the hospital with plans to reevaluate if he has another syncopal episode
E. X−ray of the cervical spine with swimmer’s view
3. A 74−year−old white man comes to the office for evaluation of his blood pressure, which recently showed two sparate
readings of 180/74 mm Hg and 176/78 mm Hg You review this chart and see that his last visit was 3 years ago, at which
time his blood pressure was 164/80 mm Hg. He currently takes no medication. He is 183 cm (6ft) tall and weighs 79 kg
(175 lb), BMI is 24 kg/m^2. Physical examination is normal except for a blood pressure of 170/80 mm Hg. You recommend
an exercise program and diet modification with decreased salt intake. At a follow0up visit 3 months later he has lost 2.2 kg
(5 lb). He says he restricted his salt intake, however, his blood pressure remains elevated at 168/70 mm Hg. You
recommend a trial of pharmacotherapy. You have reviewed the results of a randomized controlled trial assessing the
effects of antihypertensive treatment to reduce the risk for stroke. In this study, 4736men and women with elevated
systolic blood pressure were randomly assigned to a placebo, diuretic, or cardioselective beta−blocking medication.
Patients were monitored for 5 years. The effects of treatment on blood pressure are shown in the table below.
Change in blood pressure (mean mm Hg +/- standard deviation)
Assignment Systolic Diastolic
Placebo −2 +/− 4.2 +1.5 +/− 3.6
Diuretic −12.2+/−6.8* −3 +/− 4.2
Beta−blocking medication −14.3 +/− 10.7** +0.8 +/− 6.9
*p = 0.002, **p<0.01 (compared with placebo)
Item 1 of 2:
Compared with the placebo, which of the following is the most appropriate conclusion based on these data?
A. Beta−blocking medication decreases diastolic blood pressure
B. Beta−blocking medication decreases diastolic blood pressure more than the diuretic
C. Diuretic decreases diastolic blood pressure
D. Diuretic decreases systolic blood pressure
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E. Diuretic plus beta−blocking medication acts synergistically to decrease bood pressure
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4. Item2 of 2:
The patient is concerned about the potential for adverse effects of the medication and wants more information about the
benefits of treatment. You review the following results of a study related to stroke and cardiovascular events.
Risk reduction for antihypertensive therapy compared with placebo
Risk reduction for antihypertensive therapy compared with placebo
Event Relative Risk Confidence Interval
Fatal stroke 0.71 0.31 to 1.59
Nonfatal stroke 0.63 0.49 to 0.82
Transient ischemic attack 0.75 0.54 to 1.04
Myocardial infarction 0.67 0.47 to 0.96
Angioplasty 0.86 0.47 to 1.59
Coronary artery bypass grafting 0.63 0.40 to 1.00
Based on these data, you advertise the patient that reducing blood pressure through drug therapy is likely to decrease
which of the following?
A. His need for angioplasty
B. B. His need for Coronary artery bypass grafting
C. His risk for a fatal stroke
D. D. His risk for a nonfatal stroke
E. E. His risk for a transient ischemic attack
5. An 83−year−old woman is admitted to the hospital because of fever and fecal impaction. She has poor vision due to
macular degeneration and she is not very mobile. After disimpaction and recovery, she falls and breaks her hip on the
second hospital day. You refer to a case−control study of in−hospital hip fractures that notes an odds ratio of 2.0 (95%
confidence interval [CI], 1.2 to 3.3) for the presence of vision impairment. Which of these following is the most
appropriate statement regarding the 95% CI in this study?
A. On repeated trials, the probability that the odds ratio falls outside 1.2 and 3.3 is 5%
B. On repeated trials, the probability that the odds ratio is greater than 3.3 is 5%
C. On repeated trials, the probability that the odds ratio is less than 1.2 is 5%
D. On repeated trials, the probability that the odds ratio is less than 1.2 is 5%
E. The probability that the observed odds ratio arose by chance alone is less than 5%
6. A 56−year−old African American woman with a 6−year history of type 2 diabetes mellitus comes to the office for a follow−
up examination. She brings her fingerstick blood glucose log to the office and says, <I check my sugar about the three
times weekly and it has been running high lately.= Medical history is also significant for hypertension, hypercholesteremia,
and coronary artery disease, for which she underwent three−vessel coronary artery bypass grafting 2 years ago.
Medications include rosiglitazone, hydrochlorothiazide, amlodipine, atorvastatin, and aspirin. She has smoked one−half
pack of cigarettes daily for the past 40 years. She drinks one caffeinated beverage daily but does not drink alcoholic
beverages. She is 178 cm (5 ft 5 in) tall and weighs 73 kg (160 lb); BMI is 27 kg/m^2. Vitals signs are temperature 37.2 C
(98.9F), pulse 90/min, respirations 16/min, and blood pressure 135/88 mm Hg. Ocular examination discloses flat optic
discs without vascular changes. Auscultation of the neck discloses a soft right carotid bruit. Breath sounds in the upper
lung fields are decreased. Sensation is decreased to monofilament testing in the feet, bilaterally. Additional physical
examination should be directed at which of the following?
A. Axillae
B. Eyelids
C. Joints
D. Toenails
E. Tongue
7. A 57 year old Mexican American man comes to the office for evaluation of hyperlipidemia. He was hospitalized for
unstable angina and underwent a percutaneous angioplasty of the proximal left anterior descending coronary artery 3
months ago. He first had heart trouble about 7 years ago when he had a subendocardial myocardial infarction. He
stopped smoking cigarettes 1 year ago, but had smoked at least one pack daily for 25 years. His current medications are
aspirin and metoprolol, daily. His height is 170 cm (5 ft 7 in) and weight is 95 kg (210 lb); BMI is 33 kg/m^2. Vital signs are
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temperature 37.5 C (99.5F), pulse 64/min, respirations 18/min, and blood pressure 118/72 mm Hg. Results of a recent
serum lipid screening are shown:
Cholesterol
Total 280 mg/dL
HDL 32 mg/dL
LDL 202 mg/dL
Triglycerides 230 mg/dL
In addition to dietary and weight loss, you are considering drug therapy for lowering hhis serum cholesterol
concentration. You review two recent randomized, placebo−controlled studies comparing the efficacy of HMG−CoA
reductatse inhibitors with placebo in preventing recurrent cardiovascular events, including acute myocardial infarction
and death. The results of the two studies are shown
Effect of HMG CoA reductase inhibitors on cardiovascular events
Study No. of subjects Treatment
Cardiovascular events Relative risk reduction, % Absolute risk events during
study, % 95% CI reduction, %
1 4444 Drug A 20 25 (16 to 54) 7
Placebo 27
2 4159 Drug B 10 23 (8 to 38) 3
Placebo 13
Based on this information, which of the following is the correct number needed to be treated with drug B to prevent one
cardiovascular event?
A. 3
B. 7
C. 15
D. 33
E. 67
8. A 73−year−old Danish American woman with a history of osteoarthritis comes to the office because of back pain for the
past 4 weeks. She says she has pain with twisting and turning motion. On physical examination she has lancinating
midthoracic tenderness. She is 152 cm (5 ft) tall and weighs 54 kg (120 lb); BMI is 23 kg/m^2. Which of the following is the
most likely diagnosis?
A. Breast cancer
B. Compression fracture of a vertebra
C. Herniated intervertebral disk
D. Lumbosacral strain
E. Spinal stenosis
9. A 77−year−old man who is in a nursing home is seen for he first time since transfer from the hospital 1 week ago. He had
been hospitalized after a stroke. Vital signs now are normal. Physical examination shows residual hemiparesis. The patient
is slightly confused. Prostate gland is slightly enlarged. He has a Foley catheter that was inserted in the hospital because of
incontinence. Which of the following is the most appropriate next step?
A. Change to in−and−out catheterization twice per day
B. Determine serum creatinine concentration
C. Determine serum prostate specific antigen concentration
D. Obtain consultation with a urologist
E. Order ultrasonography of the prostate
