NBME CBSE REAL EXAM 200 QUESTIONS & ANSWERS LATEST
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(usmle step 1)MEDICAL EXAMINATION hj hj hj hj
1. 70yo M dies in a motor vehicle collision. Was undergoing evaluation for
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occult blood in the stool. Photo of transverse colon shown. Dx? -
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- Tubular adenoma - hj hj
2. 38yo M with 1-week hx of watery, itchy eyes and a runny nose. Physical
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shows inflamed nasal mucosa. No congestion in lower lung.
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Pharmacotherapy? -
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- Loratadine - hj
3. 16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T
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38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR shows bilateral
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interstitial infiltrates. Blood spontaenously agglutinates while awaiting
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transport to the laboratory. Antibody isotypes causing agglutination? -
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- IgM - hj
4. 24yo M with small tender blisters on his penis 3 days after unprotected
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sex. Photograph shown. Causal agent? -
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- Herpes simplex virus type 2 -
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5. 42yo F with 3-year hx of an intermittent facial rash, including the
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forehead, eyelids, nose, and cheeks. Rash seems to be getting worse since
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she moved from New York to Florida last year. Spicy foods precipitate a
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flushing reaction that seems to exacerbate the rash. PE shows erythema over
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the nose and cheeks, with scattered telangiectasias and a few papules. Dx? -
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- Rosacea - hj
,6. 53yo M returned from Africa, has fever, headache, and abdominal
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discomfort. Received appropriate vaccinations prior to the trip. T 39.4C. A
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wright-stained peripheral smear shown. Dx? -
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- Malaria - hj
7. 68yo F with T2DM and hypertension that has eben poorly controlled despite
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hydrochlorothiazide treatment. BP 150/96, Labs show serum glucose
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concentration of 130 and proteinuria. In addition to current Rx, which is most
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appropriate pharmacotherapy? -
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- Lisinopril - hj
8. 66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after
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receiving chemotherapy with flourouracil, leucovorin, and irinotecan.
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perscribed opioid antidiarrheal agent with no CNS effects. Which med? -
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- Loperamide - hj
9. 35yo M in ED with 2-hour hx of sever fatigue and dizziness. Had profuse,
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watery diarrhea for 8 hours despite a lack of oral intake. Recently returned
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from a medical relief trip to a remove village in Honduras. T 36.7 C, P
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122/min, BP 90/50. PE shows dry skin and decreased capillary refill. Stool
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for occult blood is negative; stool is gray and turbid. Gram stain shows gram-
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negative, comma-shaped bacteria; no erythrocytes of leukocytes. MOA of toxin?
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-
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- Activation of adenylyl cyclase - hj hj hj hj
10. 59yo F with gradual onset of lack of muscle control in her left arm and
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leg. Sx 1 mo ago after dx with metastatic breast cancer. PE shows ataxia of
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left upper and lower extremities. Muscle strength, DTR, sensation,
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proprioception normal. Metastatic tumor in which location? -
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- Cerebellum - hj
,11. Newborn delivered at 38 weeks' gestation weighs 1800 g. PE shows
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petechial rash, microcephaly, and hepatosplenomegaly. Serologic test for
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CMV: IgG + in mother, + in newborn; IGM - in mother, + in newborn.
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Explanation? -
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- Congenital cytomegalovirus infection - hj hj hj
12. Female newborn is delivered at 38 weeks' gestation. Apgar 8 and 8 at 1/5
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min. PE shows a bulging, fluod0filled mass approximately 5 cm in diameter
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in the midline over the lumbosacral region. No spontaneous movements of
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the lower extremities. Abnormality most likely occurred because of abnormal
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development during which periods of postconception (in days)? -
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- 15 to 40 -
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13. 64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has
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ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial fibrillation.
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Intravenous ibutilide is administered. Ten minutes later, ECG shows normal
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sinus rhythm. Risk for which drug effect in the next 6 hours? -
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- Torsades de pointes - hj hj hj
14. 65yo F with 20-year hx of osteoarthritis of the hands now has pain
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radiating down the distal anterior thigh, knee, medial leg, and food. Bony
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outgrowth of vertebrae compressing one of the spinal nerves is suspected.
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Nerve root in which intervertebral foramina is effected? -
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- L-3 to 4 -
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15. 38yo M with 3-year hx of T2DM. Taking an oral antihyperglycemic agent,
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he has tried diet and exercise. BMI 32. PE normal. Hb A1c is 10%.
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Physician recommends initiation of insulin injections. Responds, "I know that
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insulin would help control my blood sugar. But a lot of people in my family
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have diabetes, and insulin made them really sick at times. Patient is at which
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stage of change? -
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- Contemplation - hj
, 16. 24yo M with 2-day history of an itchy rash on his arms and legs.
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Returned from a camping trip in the woods 5 days ago. PE shows edematous,
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erythematous rash with linear vesicles. Cause is activation of which cell
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types? -
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- T lymphocytes -
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17. 70yo M from china with poorly differentiated monoclonal carcinoma of
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the nasopharynx. DNA probes of neoplastic cells are most likely to detect
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genome of which virus? -
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- Epstein-Barr virus - hj hj
18. Epidemiologic study of aniline dye, 500 workers with bladder cancer and hj hj hj hj hj hj hj hj hj hj
200 workers without. Exposed to aniline dyes/Have Bladder cancer: Yes/Yes
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(250), Yes/No (50), No/Yes (250), No/No (150). Odds ratio? -
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-3- hj hj
19. 24yo M with hx of IVDA could not be aroused. Friend reports that the
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patient injected himself with a drug 6 hours ago. Labs show drug
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concentration of 0.3. Assuming first-order one-compartment kinetics, has a
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half-life of 2 hours, and a volume of distribution of 200 L in this patient.
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What is quantity of drug (in mg) injected? -
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- 480 -
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20. Compound is taken up by bacterial cells. No energy is necessary for
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uptake, and the compound is not concentrated in the cell. Which describes this
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mechanism of transport? -
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- Carrier-mediated diffusion - hj hj
21. Newborn has male genital ducts but female external genitalia.
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Cytogenetic analysis shows a 46,XY karyotype, and genetic testing shows a
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mutation of the
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