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NBME 28 Exam Questions and Answers
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NBME 28 Exam Questions and Answers
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NBME 28 Exam Questions and Answers1
Exam iiSection ii1: iiItem ii1 iiof ii50
National iiBoard iiof iiMedical iiExaminers'
Comprehensive iiBasic iiScience iiSelf-Assessment
1. iiA ii25-year-old iiman iiis iibrought iito iithe iiemergency iidepartment iibecause iiof iisevere
iiabdominal iipain, iinausea, iiand iivomiting iifor ii1 iihour. iiThe iipain iioriginates iiin iithe iileft
iiflank iiand iiradiates iito iihis iigroin. iiHis iipulse iiis ii100/min, iirespirations iiare ii18/min, iiand
iiblood iipressure iiis
150/100 iimm iiHg. iiPhysical iiexamination iishows iitenderness iiof iithe iileft iiflank iiand iithe
iileft iilower iiquadrant iiof iithe iiabdomen. iiBowel iisounds iiare iimildly iihypoactive. iiTest iiof
iithe iistool iifor iioccult iiblood iiis iinegative. iiWhich iiof iithe iifollowing iibest iiexplains iithese
iifindings?
A) iiColon iineoplasm
B) iiDiverticulitis
C) iiEpididymitis
D) iiRenal iiinfarction
E) iiTorsion iiof iithe iitestis
F) iiUreteral iicalculus ii- iiAnswers ii-F.
Ureteral iicalculus iitypically iipresents iiwith iicolicky, iiunilateral iiflank iipain iiradiating iito
iithe iigroin, iiand iiwith iigross iior iimicroscopic iihematuria. iiPain iimay iibe iisignificant
iienough iito iitrigger iinausea, iias iiin iithis iicase. iiThe iicommon iitypes iiof iiurinary iitract
iicalculi iiare iicalcium iioxalate iior
phosphate, iiammonium iimagnesium iiphosphate, iiuric iiacid, iiand iicystine. iiOn iiurinalysis,
iired iiblood iicells iiwithout iicasts iiare iicommon. iiFever, iidysuria, iiand iipyuria iiwould iinot
iibe iiexpected iiunless iithere iiwas iia iiconcomitant iiinfection. iiTreatment iifor iiureteral
iicalculus iiis
symptomatic iiwith iipain iicontrol iiand iinausea iirelief. iiMost iiureteral iicalculi iipass
iispontaneously iiafter iia iiperiod iiof iiobservation iifor iipatients iiwith iiwell-controlled iipain
iiand iino iisigns iiof iisepsis iior iiinfection. iiStone iiremoval iiby iishock iiwave iilithotripsy iior
iiendoscopic iiremoval iiis iian
option iifor iipatients iirequiring iiemergency iitherapy. iiIt iiis iialso iian iioption iifor iipatients
iiwith iipersistent iiobstruction, iiuncontrolled iisymptoms, iior iifailure iiof iistone iiprogression.
iiIn iigeneral, iistones iismaller iithan ii5 iimm iiwill iipass iiwithout iioperative iiassistance.
iiObstructing iistones iimay
require iitemporary iiplacement iiof iia iiureteral iistent iito iiprevent iihydronephrosis iiand
iirenal iiparenchymal iiinjury.
Incorrect iiAnswers: iiA, iiB, iiC, iiD, iiand iiE.
Colon iineoplasm ii(Choice iiA) iiwould iibe iiunlikely iiin iian iiotherwise iihealthy iiyoung
iipatient iiwith iino iifamily iihistory iiof iipolyposis iisyndromes iiand iiacute, iisevere, iiflank
,iipain. iiIt iiwould iitypically iipresent iiwith iiinsidious iiweight iiloss, iianemia, iiconstipation, iior
iiblood iiper iirectum. iiIn
addition, iitest iifor iistool iifor iioccult iiblood iiis iinegative, iimaking iithis iidiagnosis iiunlikely.
Diverticulitis ii(Choice iiB) iican iipresent iiwith iileft iilower iiquadrant iiabdominal iipain iiand
iitenderness iibut iiwould iibe iiless iiabrupt iiin iipresentation iiand iitypically iipresent iiwith
iifever, iidiarrhea, iiand iihyperactive iibowel iisounds. iiIt iiwould iibe iiunlikely iito iicause iiflank
iipain.
Epididymitis ii(Choice iiC) iiis iia iicommon iicause iiof iipainful iiscrot
2
Exam iiSection ii1: iiItem ii2 iiof ii50
National iiBoard iiof iiMedical iiExaminers'
Comprehensive iiBasic iiScience iiSelf-Assessment
2. iiWhich iiof iithe iifollowing iitypes iiof iisensory iiinformation iiis iicompromised iiby iilesions
iiof iithe iistructure iiat iisite iiX iiin iithe iiphotograph iishown?
A) iiConscious iiproprioception
B) iiPain iisensation
C) iiTwo-point iidiscrimination
D) iiUnconscious iiproprioception
E) iiVibration iisense ii- iiAnswers ii-D.
The iianterior iilobe iiof iithe iicerebellum ii(labeled iiX, iipictured iiin iicross-section iias iian
iiarborized iibrain iiarea iiposterior iito iithe iibrainstem iiand iianterior iito iithe iiprimary iifissure
iiof iithe iicerebellum) iimediates iiunconscious iiproprioception. iiThe iianterior iilobe iiof iithe
iicerebellum iireceives
information iifrom iithe iispinocerebellar iitract iiabout iiproprioception, iior iibody iiposition,
iithat iiis iigathered iifrom iimuscle iistretch iiand iitension iireceptors iion iithe iiipsilateral iiside
iiof iithe iibody. iiThis iiproprioceptive iiinformation iiis iitransmitted iioutside iiof iiconscious
iiawareness. iiThe iideep
cerebellar iinuclei iiuse iithis iiproprioceptive iiinformation iito iicontrol iimotor iilearning,
iimovement iicourse iichanges, iiand iibalance. iiDamage iito iithe iianterior iilobe iiof iithe
iicerebellum, iiwhich iicommonly iioccurs iiin iichronic iialcoholism, iimay iilead iito iibroad-
based iigait iiataxia.
Incorrect iiAnswers: iiA, iiB, iiC, iiand iiE.
Conscious iiproprioception ii(Choice iiA), iitwo-point iidiscrimination ii(Choice iiC), iiand
iivibration iisense ii(Choice iiE) iiare iimediated iiby iithe iidorsal iicolumn-medial iilemniscus
iipathway, iiwhich iirelays iithis iisensory iiinformation iiup iithe iispinal iicord iito iithe iithalamus
iiand iiterminates iiin iithe
primary iisensory iicortex iiin iithe iiparietal iilobe. iiThe iicortex iiis iia iihigh-order iibrain iiarea
iiinvolved iiin iiseveral iiconscious iibrain iifunctions, iiwhich iireflects iithis iipathway's
iimediation iiof iithe iiconscious ii(rather iithan iiunconscious) iiawareness iiof iiproprioception.
Pain iisensation ii(Choice iiB) iiis iimediated iiby iithe iispinothalamic iipathway. iiThe
iispinothalamic iipathway iitransmits iiinformation iiabout iipain, iitemperature, iiand iicrude
iitouch iiup iithe iispinal iicord iito iithe iithalamus, iiterminating iiin iithe iiprimary iisensory
iicortex.
Educational iiObjective: iiThe iianterior iilobe iiof iithe iicerebellum iimediates iiunconscious
iiproprioception, iiwhereas iiconscious iiproprioception iiis iicontrolled iiby iithe iidorsal
,iicolumn-medial iilemniscus iipathway. iiLesions iiof iithe iianterior iilobe iiof iithe iicerebellum
iican iiresult iiin iibroad-
based iigait iiataxia.
%3D
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3
Exam iiSection ii1: iiItem ii3 iiof ii50
National iiBoard iiof iiMedical iiExaminers®
Comprehensive iiBasic iiScience iiSelf-Assessment
3. iiMoving iithe iiforearm iiagainst iiresistance iifrom iipalm-down iito iipalm-up ii(supination)
iiposition iirequires iithe iiuse iiof iiwhich iiof iithe iifollowing iimuscles?
A) iiBiceps iibrachii
B) iiBrachialis
OC) iiTriceps
D) iiFlexor iicarpi iiradialis
E) iiPronator iiteres ii- iiAnswers ii-A.
The iibiceps iibrachii iimuscle iihas iitwo iimain iiactions, iiflexion iiof iithe iielbow iijoint iiand
iisupination iiof iithe iiforearm. iiThe iibiceps iibrachii iicontains iitwo iiproximal iiheads, iiwith
iithe iishort iihead iiattaching iito iithe iicoracoid iiprocess iiof iithe iiscapula iiand iithe iilong
iihead iientering iithe iishoulder
joint iiand iiattaching iito iithe iisupraglenoid iitubercle. iiThe iidistal iibiceps iitendon iiinserts
iion iithe iibicipital iituberosity iiof iithe iiproximal iiradius. iiBecause iiof iiits iiorientation
iicrossing iithe iielbow iijoint, iicontraction iiof iithis iimuscle iicauses iielbow iiflexion. iiIts
iieccentric iiinsertion iion iithe
proximal iiradius iiallows iifor iiit iito iiwind iiaround iithe iiradius iiduring iipronation iiand
iiunwind iiwhen iicontracted iifrom iiaround iithe iiproximal iiradius iiduring iisupination.
Incorrect iiAnswers: iiB, iiC, iiD iiand iiE.
The iibrachialis iimuscle ii(Choice iiB) iioriginates iion iithe iianterior iisurface iiof iithe iihumerus
iiand iicrosses iithe iielbow iiinserting iion iithe iituberosity iiof iithe iiulna. iiIt iidoes iinot iiwrap
iiaround iithe iiulna iiand iithe iiulna iidoes iinot iirotate. iiBecause iiof iithis, iiit iidoes iinot
iicontribute iito iisupination iior
pronation.
The iitriceps iimuscle ii(Choice iiC) iiserves iito iiextend iithe iielbow iijoint. iiProximally, iiit
iioriginates iifrom iithe iiinfraglenoid iitubercle iiof iithe iiscapula ii(long iihead), iijust iiproximal
iito iithe iiradial iigroove ii(lateral iihead), iiand iijust iidistal iito iithe iiradial iigroove ii(medial
iihead). iiDistally, iiit iiinserts iion
the iiolecranon iiprocess iiof iithe iiulna. iiContraction iiof iithis iimuscle iiextends iithe iielbow
iiand iidoes iinot iicontribute iito iirotation.
Flexor iicarpi iiradialis ii(Choice iiD) iioriginates iion iithe iimedial iiepicondyle iiof iithe
iihumerus iiand iiinserts iion iithe iisecond iiand iithird iimetacarpal iibones. iiThis iiallows iifor
iiflexion iiof iithe iiwrist.
Pronator iiteres ii(Choice iiE) iiis iia iimuscle iiof iithe iiproximal iiforearm iithat iiextends iifrom
iithe iimedial iisupracondylar iiridge iiof iithe iihumerus iiand iiinserts iion iithe iilateral iiaspect
iiof iithe iiradius. iiContraction iialong iithis iiaxis iiwill iipromote iipronation, iinot iisupination.
, Educational iiObjective: iiThe iibiceps iibrachii
4
Exam iiSection ii1: iiItem ii4 iiof ii50
National iiBoard iiof iiMedical iiExaminers'
Comprehensive iiBasic iiScience iiSelf-Assessment
4. iiA ii35-year-old iiman iiis iiadmitted iito iithe iihospital iibecause iiof iia ii5-day iihistory iiof
iifever iiand iidyspnea. iiHe iiunderwent iia iibone iimarrow iitransplantation ii6 iimonths iiago;
iithe iiprocedure iiwas iicomplicated iiby iisevere iigraft-versus-host iidisease. iiHis
iitemperature iiis ii38°C
(100.4°F), iiand iirespirations iiare ii30/min. iiScattered iicrackles iiare iiheard iion
iiauscultation iiof iithe iichest. iiA iichest iix-ray iishows iipatchy iiinfiltrates. iiA iitransbronchial
iibiopsy iispecimen iishows iifindings iiconsistent iiwith iicytomegalovirus iiinfection.
iiIntravenous iiadministration iiof
ganciclovir iiis iibegun. iiThis iidrug iiinterferes iiwith iithe iifunction iiof iiwhich iiof iithe iifollowing
iienzymes?
A) iiDNA iipolymerase
B) iiIntegrase
C) iiReverse iitranscriptase
D) iiRNA iipolymerase
E) iiThymidine iikinase ii- iiAnswers ii-A.
Cytomegalovirus ii(CMV), iialso iiknown iias iihuman iiherpesvirus ii5 ii(HHV-5), iiis iian
iiopportunistic iiinfection iicommonly iioccurring iiin iiimmunocompromised iipatients iiwith
iisolid-organ iior iiallogeneic iibone iimarrow iitransplantation, iisevere iiulcerative iicolitis, iior
iiHIV/AIDS iiinfection. iiIt
can iibe iitransmitted iithrough iimultiple iimodes, iiincluding iisexual iicontact, iiurine,
iirespiratory iidroplets, iiand iito iia iifetus iivia iithe iiplacenta. iiIt iican iicause iia iivariety iiof
iipresentations, iiincluding iimononucleosis iiin iiimmunocompetent iipatients, iiand iiretinitis,
iiesophagitis, iiand iipneumonia
in iiimmunocompromised iipatients. iiTreatment iifor iiall iihuman iiherpesvirus iiinfections
iiinvolves iidrugs iithat iiinhibit iiviral iiDNA iipolymerase, iiclassically iiby iiguanosine iianalogs
iisuch iias iiacyclovir, iivalacyclovir, iiand iifamciclovir. iiPrior iito iiexerting iitheir iiantiviral
iieffects, iimost
guanosine iianalogs iimust iibe iiphosphorylated iiby iithe iiviral iienzyme iithymidine iikinase.
iiThey iiare iithen iiable iito iiinhibit iithe iiviral iiDNA iipolymerase iiby iiterminating iithe iinascent
iiDNA iichain iiduring iireplication. iiThese iidrugs iiare iieffective iiagainst iiherpes iisimplex
iivirus iiand iivaricella
zoster iivirus, iiweakly iieffective iiagainst iiÉpstein-Barr iivirus, iiand iinot iieffective iiagainst
iiCMV, iiwhich iidoes iinot iihave iithe iinecessary iithymidine iikinase iineeded iifor
iiphosphorylation. iiHowever, iiit iidoes iihave iithe iinecessary iiphosphorylating iienzyme iito
iiactivate iiganciclovir, iianother
guanosine iianalog iithat iiinhibits iiDNA iipolymerase, iiand iithus iithis iiis iian iieffective iianti-
viral iitreatment iifor iiCMV.
Incorrect iiAnswers: iiB, iiC, iiD, iiand iiE.
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