NBME EXAM Question Bank ( Latest Exam
Questions & Answers) All Answered
A 67-year-old woman is hospitalized because of abdominal pain and persistent
copious vomiting for 24 hours. Two weeks ago, she was hospitalized for treatment
of atrial fibrillation; after cardioversion to a normal sinus rhythm, she began
treatment with warfarin. Yesterday, at a follow-up visit, her INR was 6 (??
normal), and her medication was discontinued. She takes no other medications.
Her temperature is 37°C (98.6°F), pulse is 120/min and regular, respirations are
20/min, and blood pressure is 100/78 mm Hg. The abdomen is distended and
moderately tender; there is voluntary guarding in the epigastrium (??? source of
pain) There are no masses, organomegaly, or obvious hernias. Rectal examination
shows no abnormalities. Test of the stool for occult blood is negative. Her
hemoglobin concentration has decreased from 13 g/dL yesterday to 7.8 g/dL today.
An ECG shows a normal sinus rhythm. Which of the following is th
- Intramural hematoma of the proximal small bowel
A 4-year-old boy is brought to the physician by his parents because of fatigue and
irritability over the past 2 months. The family visited relatives in rural Louisiana 5
months ago where the patient ran around barefoot. The child is active and appears
normal. The conjunctivae are pale. Laboratory studies include a normal leukocyte
count with 15% eosinophils. A stool preparation discloses the parasite egg shown.
Which of the following is the most likely cause of fatigue and irritability in this
patient?
- Microcytic anemia
Two days after beginning primaquine for malaria prophylaxis, a 17-year-old
African American boy is brought to the physician because of dark urine and
yellowing of his eyes. His pulse is 88/min, respirations are 12/min, and blood
pressure is 124/68 mm Hg. Examination shows scleral icterus and pale mucous
membranes. His hemoglobin concentration is 10 g/dL. A blood smear shows
erythrocyte fragments and Heinz bodies. Which of the following is the most likely
explanation for these findings?
- Deficiency of glucose 6-phosphate dehydrogenase
,A one-day-old newborn male is found to have hemolytic disease of the newborn.
Both parents are Rh-positive, mother is positive for IgG isohemagglutinins, while
father is negative. Which of the following parental blood types most likely caused
this condition?
- Mother: O and Father: AB
One week after receiving 4 units of packed red blood cells for acute hemorrhage
due to a gunshot wound, a 17-year-old male develops fatigue, jaundice. Laboratory
results show the following:Hemoglobin 8.8 g/dL Hematocrit 28%, Serum total
bilirubin 5 mg/dL Serum lactate dehydrogenase 120 U/L. Liver and kidney
function tests are otherwise within normal limits. Which of the following is the
most appropriate next step in diagnosis?
- Direct and indirect antiglobulin (Coombs) tests
A 6-month-old boy is brought to the physician because of left knee swelling for 24
hours. Three months ago, he had three large hematomas on his forehead that
resolved without treatment (??). His two sisters and his mother have no history of
similar symptoms. His mother's maternal uncle and her brother died (x-linked
recessive) before the age of 30 years of massive cerebral hemorrhages. Physical
examination shows deep ecchymosis over the buttocks and severe swelling of the
left knee. The most likely explanation for these findings is a deficiency of which of
the following?
- Factor VIII (antihemophilic factor)
Three days after undergoing elective laparoscopic cholecystectomy for
cholelithiasis, a 42-year-old woman has the onset of hematomas at all surgical
sites. She was treated for deep venous thrombosis 3 years ago but was not taking
any medications at the time of this admission. Results of preoperative laboratory
studies were within the reference range. Prior to the operation, she received
heparin and underwent application of compression stockings. Her initial
postoperative course was uncomplicated. Heronly medication is ibuprofen. She is
163 cm (5 ft 4 in) tall and weighs 87 kg (192 lb); BMI is 33 kg/m2. Her
temperature is 37.3°C(99.2°F), pulse is 94/min, respirations are 16/min, and blood
pressure is 112/74 mm Hg. Examination shows mild hematomas at all surgical
,sites. The abdomen is soft and nontender. There is no organomegaly. Bowel
sounds are normal. Laboratory studies show:Hemoglobin 10.3 g/dL Hematocrit
30%Leuk
- Heparin-induced thrombocytopenia
A 3-year-old girl with Down syndrome is brought to the physician because of a 1-
week history of frequent nosebleeds, decreased appetite, and lethargy. She takes no
medications. Her temperature is 38°C (100.4°F), pulse is 100/min, respirations are
20/min,and blood pressure is 80/45 mm Hg. Examination shows no other
abnormalities except for pallor. Laboratory studies show:Hemoglobin 6.5 g/dL
Hematocrit 19%Leukocyte count 100,000/mm3 Segmented neutrophils
15%Atypical lymphocytes 85%Platelet count 45,000/mm3 Which of the following
is the most likely mechanism of these laboratory findings?
- Infiltration of bone marrow by leukemic blasts
A 30-year-old woman, gravida 2, para 1, comes for her first prenatal visit at 26
weeks' gestation. Uterine size is greater than expected for dates. Ultrasonography
shows fetal hydrops. Which of the following is the most appropriate next step in
diagnosis?
- Maternal Rh status with antibody screening
A 65-year-old man has had increasingly severe headaches and diffuse muscle
aches during the past 3 months. He also has a 1-month history of jaw pain when
chewing food and decreasing visual acuity in his left eye. His temperature is 38°C
(100.4°F). Visual acuity in his left eye is 20/100, and the left optic disc is slightly
atrophic. His muscle strength is normal. Which of the following tests should be
obtained next?
- Measurement of erythrocyte sedimentation rate
A 10-year-old boy has had anemia since birth. His spleen is five times normal size.
Splenectomy is indicated if the anemia is caused by which of the following
disorders?
- Hereditary spherocytosis
, A previously healthy 72-year-old man is brought to the physician because of
weakness and fatigue. His hemoglobin concentration is 9.2 g/dl, leukocyte count is
5400/mm3, and platelet count is 350,000/mm3. A peripheral blood smear is shown.
Which of the following is the most likely cause of these findings?
- Gastrointestinal blood loss
A 48-year-old man comes to the physician because of increasing bronzing of his
skin, weakness, and fatigue during the past 3 months. Physical examination shows
bronzing of the skin, hepatomegaly, and small testes. Serum studies show: Which
of the following best explains the findings in this patient? - Increased intestinal
iron absorption
A 3-year-old boy and his 5-year-old brother bruise easily and have recurrent
hemarthrosis. Both parents are healthy, but the mother has two younger brothers
with the same symptoms and a maternal uncle who died at 8 years of age after mild
head trauma. Partial thromboplastin time is prolonged. The most likely defect
involves which of the following? - Factor VIII (antihemophilic factor)
An 81-year-old woman is admitted to the hospital because of a massive pulmonary
embolism from a deep venous thrombosis. Her platelet count is 160,000/mm3.
Appropriate pharmacotherapy is started. One week later, her platelet count is
55,000/mm3. The thrombocytopenia was most likely caused by a drug with which
of the following mechanisms of action? - Potentiates the action of antithrombin III
A 62-year-old woman with recurrent pulmonary emboli comes to the physician for
a follow-up examination. Physical examination shows no abnormalities.
Laboratory studies show a prothrombin time of 12 seconds. Warfarin therapy is
begun. Which of the following clotting factors is the first to be decreased by 50%
after the initiation of therapy? - VII (proconvertin)
A 40-year-old man is evaluated because his skin is extremely sensitive to sunlight.
Exposure to the sun causes the formation of vesicles and blisters on the skin, which
frequently take weeks to heal. He is diagnosed with a disorder caused by the
increased synthesis of compounds in the skin that are subject to excitation by
