NBME CBSE REAL EXAM 200
QUESTIONS AND ANSWERS LATEST
2023-2024 (usmle step 1)MEDICAL
EXAMINATION LATEST UPDATES MAY 2023 A GRADE.
40yo F with 1-year hx of episodes of crampy abdominal pain, intermittent diarrhea, and rectal bleeding
with passage of mucus. BMI 18. Abdominal exam: diffuse tenderness with no rebound.
Sigmoidoscopy shows diffuse ulcers. Initial Rx? - ANSWER- Sulfasalazine
27yo M for employment exam. No Hx of major illness. Never been
sexually active. Minimal contact with parents and siblings, no hobbies. Doesn't feel depressed. Shrugs
in response to congratulations about his
new job. Flat affect. Personality disorder? - ANSWER- Schizoid
30yo F has ptosis, ophthalmoplegia, and diplopia. Serum shows autoantibody with affinity for
acetylcholine receptor at the postsynaptic neuromuscular junction. Which neoplasm? - ANSWER-
Thymoma
Exam scaled so scores are normally distributed with mean of 500 and
SD of 100. Which % are between 400 and 600? - ANSWER- 67%
62yo M with pericardial friction rub 3 days after acute myocardial
infarction. Cause of rub? - ANSWER- Fibrinous pericarditis
42yo F with 1-mo Hx of abdominal pain, after eating fatty meals. BMI
31. PE shows jaundice and tenderness of RUQ. Increase of which liver
function? - ANSWER- Cholesterol synthesis
,70yo M with recent loss of mental function. Hx of weight loss. No drugs. VSS, not dehydrates. Mild
anemia. Labs show Na 110, Cl 85, K 4.4, BUN 15, Cr 15; Plasma osmolality 250; Urine osmolality 750. Dx?
- ANSWER- Pulmonary neoplasm
38yo F with 2-year hx of pain and heavy flow with menses causes her to miss work. Ibuprofen not
effective. One 6yo daughter; unable to conceive another child. PE shows mildly enlarged left ovary and
retroflexed uterus. U/S shows substantial evidence of ovarian cysts and one peritoneal cyst. Bx of cyst
will show? - ANSWER- Proliferative endometrial tissue
40yo M skin extremely sensitive to sunlight, which causes formation of vessicles and blisters on the skin
which take weeks to heal. Diagnosed with disorder caused by increased synthesis of compounds in the
skin that are subject to excitation by visible light. Which biochemical pathway is defective? - ANSWER-
Heme synthesis
60yo M with 6-month hx of fatigue. Four years ago, had subtotal gastrectomy after gunshot wound.
Drinks 6-8 beers daily. PE shows paresthesias of both hands. Labs show: Hb 8, HCT 24%, MCV 115, WBC
5k, Platelets 165k, RBC Folic acid 500 (N = 125-600), B12 10 (N
= 160-195). Cause is absence of? - ANSWER- Parietal cells
RCT to compare wound healing and cosmetic differences between two surgical procedures for closing
skin after C section. Surgical specialists cannot be blinded to the procedure. Results show procedure A
has a lower rate of wound infection compared with B (relative risk 0.66, 95% CI 0.3 - 1.45). Which
accurately represents comparison between A and B? - ANSWER- Neither procedure is superior?
40yo M with interstitial pulmonary fibrosis has greater maximal expiratory flow rate than predicted.
Which best explains this? - ANSWER- Increased radial traction on airways
70yo M dies in a motor vehicle collision. Was undergoing evaluation for
occult blood in the stool. Photo of transverse colon shown. Dx? -
ANSWER- Tubular adenoma
,38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical
shows inflamed nasal mucosa. No congestion in lower lung.
Pharmacotherapy? - ANSWER- Loratadine
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P 88/min, BP 102-70. PE
shows pale conjunctivae. CXR shows bilateral interstitial infiltrates. Blood spontaenously agglutinates
while awaiting transport to the laboratory. Antibody isotypes causing
agglutination? - ANSWER- IgM
24yo M with small tender blisters on his penis 3 days after unprotected
sex. Photograph shown. Causal agent? - ANSWER- HSV-2
42yo F with 3-year hx of an intermittent facial rash, including the forehead, eyelids, nose, and cheeks.
Rash seems to be getting worse since she moved from New York to Florida last year. Spicy foods
precipitate a flushing reaction that seems to exacerbate the rash. PE shows erythema over the nose and
cheeks, with scattered telangiectasias and a few papules. Dx? - ANSWER- Rosacea
53yo M returned from Africa, has fever, headache, and abdominal
discomfort. Received appropriate vaccinations prior to the trip. T 39.4C.
A wright-stained peripheral smear shown. Dx? - ANSWER- Malaria
68yo F with T2DM and hypertension that has been poorly controlled despite hydrochlorothiazide
treatment. BP 150/96, Labs show serum
glucose concentration of 130 and proteinuria. In addition to current Rx,
which is most appropriate pharmacotherapy? - ANSWER- Lisinopril
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving chemotherapy with
fluorouracil, leucovorin, and Irinotecan. prescribed opioid antidiarrheal agent with no CNS effects.
Which med? - ANSWER- Loperamide
35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse, watery diarrhea for 8 hours
despite a lack of oral intake. Recently returned from a medical relief trip to a remove village in
, Honduras. T 36.7 C, P 122/min, BP 90/50. PE shows dry skin and decreased capillary refill. Stool for
occult blood is negative; stool is gray and turbid. Gram stain shows gram-negative, comma-shaped
bacteria; no erythrocytes of leukocytes. MOA of toxin? - ANSWER- Activation of adenylyl cyclase
59yo F with gradual onset of lack of muscle control in her left arm and leg. Sx 1 mo ago after dx with
metastatic breast cancer. PE shows ataxia of left upper and lower extremities. Muscle strength, DTR,
sensation,
proprioception normal. Metastatic tumor in which location? - ANSWER- cerebellum
Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows petechial rash, microcephaly, and
hepatosplenomegaly. Serologic test for CMV: IgG + in mother, + in newborn; IGM - in mother, + in
newborn. Explanation? - ANSWER- Congenital cytomegalovirus infection
Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5 min. PE shows a bulging,
fluod0filled mass approximately 5 cm in diameter in the midline over the lumbosacral region. No
spontaneous movements of the lower extremities. Abnormality most likely occurred because of
abnormal development during which periods of postconception (in days)? - ANSWER- 15 to 40
64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has ischemic heart disease. P
125/min, BP 105/60. ECG shows atrial fibrillation. Intravenous ibutilide is administered. Ten minutes
later, ECG shows normal sinus rhythm. Risk for which drug effect in the next
hours? - ANSWER- torsades de pointes
65yo F with 20-year hx of osteoarthritis of the hands now has pain radiating down the distal anterior
thigh, knee, medial leg, and food. Bony outgrowth of vertebrae compressing one of the spinal nerves is
suspected. Nerve root in which intervertebral foramina is effected? - ANSWER- L3 to L4
38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic agent, he has tried diet and exercise.
BMI 32. PE normal. Hb A1c is 10%. Physician recommends initiation of insulin injections. Responds, "I
know that insulin would help control my blood sugar. But a lot of people in my family have diabetes, and
insulin made them really sick at times. Patient is at which stage of change? - ANSWER- contemplation
24yo M with 2-day history of an itchy rash on his arms and legs.
Returned from a camping trip in the woods 5 days ago. PE shows edematous, erythematous rash with
linear vesicles. Cause is activation of which cell types? - ANSWER- T lymphocytes
