NBME CBSE ACTUAL TEST QUESTIONS AND
ANSWERS (QUIZ BANK WITH ALL THE CORRECT
ANSWERS) (USMLE STEP 1) MEDICAL
EXAMINATION A+
62 year old woman - osteoporosis - a bisphosphonate is prescribed. The expected beneficial
effect of the drug is due to which of the following? -Answer- Decreased Osteoclast Activity
Cohot Study of elderly women - relative risk ratio for hip fractures among those who exercise
regularly is 1.2 (95% confidence interval of 1.1 to 1.8). Which of the following is the conclusion
about the effect of exercise on the risk of hip fracture? -Answer- Statistically Significant Overall
Increase Risk
52 year old man goes to ER with chest pain radiating to his jaw while shoveling snow. Pulse is
80/min and blood pressure is 130/70. The most immediate treatment mechanism of action? -
Answer- Increased nitric oxide concentration
24 year old woman - spilled hot grease on her left leg while working at a fast-food restaurant.
Exam of leg shows 7cm pink, soft, granular, edematous wound. The formation of this tissue was
most likely caused by increased activity of which? -Answer-
a. Vascular Endothelial Growth Factor VEGF - stimulates angiogenesiss.
TYPE III Collagen = Blood Vessels - early wound repair
27 year old man- MVC - skull x-ray shows a linear, nondepressed basal skull fracture - increased
serum osm and decreased urin osm. Following desmopressin urine osm increases.
Desmopressin's effect is due to the activation of which of the following? - Answer- a. Adenylyl
Cyclase
Adenylate Cyclase - ATP - CAMP -- PROTEKINASE A -- Ca v2
A 10 month old boy - 4 day history of fever and cough. He attends day care center. Chest exam
shows intercostal retractions along with bilateral, diffuse wheezes and expiratory rhonchi. The
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infectious agent most likely has which of the following properties? -Answer- Mediation of Cell
Entry via a fusion protein
A 17 year old girl in ED - 15 minutes after being stung by a bee. Mild light headedness but no
difficulty swallowing- Bilateral wheezing - Which is most appropriate pharmacotherapy for this
patient? -Answer- B2- Agonist
14 year old boy - 2 day history of sore throat and fever that peaks in late afternoon. 1 week of
fatigue. He recentaly had sex with one partner. Physical exam show cervical lymphadenopathy
and pharyngeal erythema with a creamy exudate. DX? -Answer- Infectious Mononucleosis
57 year old man - radiation therapy for squamous cell carcinoma of the lung. Despite therapy,
tumor increases in size and he dies 6 months later. The progressive tumor growth is due to a
defect in cell cycle arrest in which of the following phases of cell cycle? -Answer- G1
28 year old - lived in sub-Saharan Africa - until he came to the US. Temp of 100.4 - imaging
shows bilateral hydroureter and hydronephrosis. Biopsy shows marked fibrosis and scattered
granulomas. DX? -Answer- Schistosomiasis
A couple with a family history of a-thalassemia. Woman has one gene deletion and man has two
gene deletion. If the two gene is trans - what percentage of offspring will have a two gene
deletion? -Answer- 50%
previously healthy 40 year brought to emergency department by her husband - 2 day history of
fever, lethargy, confusion. PE shows scattered petechiae and ecchymoses over the lower
extremities - 3+ polychromasia and 3+ schistocytes and Low platelets Dx? -Answer- Thrombotic
Thrombocytopenia Purpura
16 year old boy - is admitted to the ER because of a knife wound to the left side of his chest. An
X-ray of the chest shows an air-fluid level in the left side of the chest, partial collapse of the left
lung, and the elevation of the stomach bubble. The mediastinum is midline. DX? -Answer-
Hemopneumpothorax under tension
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49 year old woman - coronary artery disease - BP 140/90 - High Cholesterol, High LDL (190),
High triglycerides (350) - TX with atorvastatin and losartan. What are the effects on HDL and
Triglycerides? -Answer- HDL increased
Triglycerides Decreased
73 yeare old - diffuse weakness and tingling of her arms and legs. Sensation and vibration and
position is decreased in all extremities. What vitamin deficiency? -Answer- Vitamin B12 -
(cyanocobalamin)
Tea and Toast - low B12 in diet
15 year old girl - 3 month history of acne - which is the underlying cause of the patients acne? -
Answer- Stimulation of Sebaceous Glands by androgens
b. ACNE = Propionibacterium ACNE
4 year old from Brazil - PE shows single 12x10cm lesion in the right side of jaw with diffuse
regular edges. Photomicrographs of an incisional biopsy (looks like Burkitts Lymphoma/ Starry
night) - which of the processes most likely to occur in the region indicated by the arrow? -
Answer- Apoptosis
b. Endemic Burkitt lymphoma can happen in Brazil as well as Africa (jaw lesion, puffy face).
51 year old - lump on tongue - 1 pack smoking history for 30 years. 1.5 cm mass on apex of
tongue. It is most appropriate to evaluate which lymph nodes first for evidence of metastasis? -
Answer- Submental
15 year old boy - ER - 2 hour history of confusion and agitation - fever, headache, stiff neck, and
vomiting - since returned from summer camp - patient is hallucinating - lumbar puncture - shows
cysts and trophozoites- most likely pathogen? -Answer- a.
Olfactory Nerve Naegleria fowleri
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17 year old - ED - 30 minutes after being found with a blank stare. Physical exam shows rigidity.
During exam he becomes hostile and assaults physician - Pt ingested which drug? -Answer- PCP
Placebo controlled clinical trial - 5000 pts with essential hypertension. 2500 patients receive new
drug and 2500 patients receive placebo. If alpha is set at 0.01 instead of 0.05, which of the
following is most likely result? -Answer- Significant findings can be reported with greater
confidence
17 year old - gymnast - comes to hospital because of lack of menstrual period for 6 months. BMI
15 Which is the cause of the amenorrhea? -Answer- Hypogonadotropic Hypogonadism
A male stillborn is delivered at 32 weeks - Oligohydramnios - absence of a urethral opening.
Which is most likely finding? -Answer- Pulmonary Hypoplasia
A 6 day old - breast fed boy in ED - poor weight gain and irritability since delivery - Physical
exam shows jaundice and hepatomegaly. The concentration of which of the following
metabolites is most likely increased? -Answer- a. Galactose - 1 - phosphate
b. Congenital intolerance to breast milk
A 25-year-old man - comes to ED - severe muscle pain, diffuse, painful swelling of his neck,
underarms, and groin after camping in New Mexico Generalized scattered black maculae.
Examination of the right upper extremity shows erythematous, solid, tender mass. Mass is
draining blood and necrotic material. The most effective antibiotic for patient disorder will
interfere with which of the following processes? -Answer- a.
Ribosomal Assembly
b. Yersenia Pestis
45 year old - progressive weakness - muscle fasciculations of the upper extremities and weakness
of the lower extremity - What additional findings? -Answer- Atrophy
b. ALS = Lou Gherig
A new severe respiratory illness - Why use a killed vaccine vs a live vaccine? -Answer-
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