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New Versions of NBME TESTS -
T- 18, T-20, T-21, T -22, T-23 , T-
24, T -120 (answered_2022)
56 y/o - brought to ER - Chest Pain mowing the lawn - Hypotension, PE shows cool,
clammy, diaphoretic skin. 2 hours after admission, pulmonary catherization shows
pulmonary artery pressure 40/25. Left Atrial Pressure 25 g (pulmonary emboli). Compared
with a healthy person- sets of pulmonary pressure changes?
✅ - Hydrostatic Pressure High,
Capillary hydrostatic pressure high
Interstitial Oncotic pressure Low
cardiogenic shock, the extra blood increases capillary hydrostatic pressure, driving fluid
into the interstitial space.
67 y/o - brother has history of colon cancer. Physician recommends colonoscopy, but the
patient says she would prefer stool culture instead. Physician explains that testing the stool
for occult blood is not appropriate. Physician concerned about?
✅ - Low Sensitivity
A 62 y/o - 1 week of muscle cramps - trouble opening jars and using silverware. PE shows
muscle weakness and exaggerated deep tendon reflexes. What is appropriate systemic
treatment for muscle cramps and spasms?
✅ - agonist at GABAb Receptors
41 y/o schedule for dialysis catheters. Surgeon asks the resident to get the consent. The
resident has never seen this procedure performed and has read little about it. Which of the
following actions by the resident is most appropriate?
✅ - Ask attending to obtain informed consent
A 2 year old - undergoes resection of right kidney - chronic infection secondary to influx.
The left kidney is grossly normal. Which structural adaptations will eventually occur in left
kidney?
✅ - increase in glomerular size
Congenital solitary functioning kidney
compensatory hypertrophy of contralateral kidney
,A 54 y/o woman - terminal metastatic pancreatic cancer - She asks physician to prescribe
sufficient meds to commit suicide due to unbearable pain. Physicians refuses - but will do
anything to help pain. Physician decision is most consistent with which?
✅ - Nonmaleficence
22 y/o woman - recently emigrated from rural Mexico - 20 minutes after generalized tonic-
clonic seizures. 6 week history of headaches, nausea, vomiting. Funduscopic exam shows
bilateral papilledema. An MRI of the brain shows enlargement of right ventricle consistent
with Cysticercosis. Which is mostly likely mechanism of hyderocephalus?
✅ - Obstruction of right interventricular foramen (foramen of Monroe)
22 y/o woman - recently emigrated from rural Mexico - 20 minutes after generalized tonic-
clonic seizures. 6 week history of headaches, nausea, vomiting. Funduscopic exam shows
bilateral papilledema. An MRI of the brain shows enlargement of right ventricle consistent
with Cysticercosis. Which is mostly likely mechanism of hyderocephalus?
✅ - Obstruction of right interventricular foramen (foramen of Monro)
59 y/o - develops fatigue and decreased appetite 3 months after receive mechanical aortic
valve replacement. PE shows scleral icterus and elevated JVP. Lab studies show total
bilirubin 4 elevated and direct bilirubin 1. Which is the cause of the jaundice in this patient?
✅ - Hemolysis
Prosthetic heart valves / aortic stenosis- hemolytic anemia secondary to mechanical
destruction of RBCs.
71 y/o man - 6 month history of calf pain and discomfort when he walks. He has HTN,
T2DM, weak dorsalis pedis, and ankle brachial index. The physician knows a drug that
would improve symptoms by altering platelet function and providing direct arterial
vasodilation- Which drug?
✅ - Cilostazol
phosphodiesterase inhibitor; leads to increased cAMP which inhibits platelet
degranulation/activation while also causing vasodilation
A 3 month-old boy - facial abnormalities and weakness since birth. PE shows coarse facial
features and hypotonia. Mucopolysaccharides within reference range. Concentrations of
lysosomal enzymes are increased in serum and decreased in cultured skin in fibroblasts.
Which of the following is decreased in patient's lysosomal enzymes?
✅ - Decreased Mannose-6-phosphate
,A Newborn with lethal chromosome defect. He is unable to suck sufficiently. He has
episodes of crying that occur every 2.25 hours and relieved by tube feeding. Which best
describes the most appropriate clinical approach?
✅ - feed by whatever necessary to maintain comfort
An 18 y/o woman - fever, sore throat, fatigue for 1 week. Temp 100.6. PE shows pharyngeal
erythema, generalized tender lymphadenopathy, splenomegaly. Lab show 20% atypical
lymphocytes. Which accounts for atypical lymphocytes in patients peripheral blood smear?
✅ - Reactive T - Lymphocytes
51-year-old man - acute onset of fever and respiratory failure 6 weeks after cadaveric renal
transplant. He currently takes cyclosporine, bactrim, prednisone, and TMP_SMX. Temp high
- Respirations increased. Diffuse inspiratory and expiratory crackles. Creatinine increased.
X-ray of chest shown. Cause?
✅ - Cytomegalovirus
Organ transplant patients are at an increased risk of CMV pneumonia.
A 2 month old - 6 week history of constipation. She has poor feeding, sleepiness, and yellow
skin. Her parents are migrant workers and have not received routine medical care. PE
shows lethargy, hypotonia, jaundice, large fontanelles, macroglossia, and umbilical hernia.
Most appropriate next step to establish diagnosis?
✅ - Thyroid Function Test
CRETINISM
A 39 y/o reports bright red spots on toilet paper after defecating. Rectal examination
shows large swollen rectal veins. Which is predisposing cause of these lesions?
✅ - constipation
Large swollen rectal veins --> patient has external hemorrhoids.
Swollen and inflamed veins in the rectum and anus that cause discomfort and bleeding.
The most common cause of external hemorrhoids is repeated straining while having a
bowel movement.
A 45 y/o develops proteinuria and hematuria. She has taken 3g of ibuprofen for headaches
daily for the past 2 years. Which of the following is most likely obtained on renal biopsy? ✅
- Tubulointerstitial nephritis
Acute interstitial renal inflammation. Pyuria (classically eosinophils) and azotemia
occurring after administration of drugs that act as haptens, inducing hypersensitivity (eg,
diuretics, NSAIDs, penicillin derivatives, proton pump inhibitors, rifampin, quinolones,
sulfonamides).
, A 92 y/o - recently admitted to a nursing home because of progressive dementia has large
purpuric lesions over the dorsa of both forearms and hands. Family states shew had similar
lesions over the years. Lesions occur in absence of trauma. Platelet count is normal. Which
is most likely explanation for purpura? ✅ - atrophy of dermal collagen
10-year-old boy has mass in ventral midline of the neck just inferior to hyoid bone. This
structure is developed from which of the following embryonic tissues?
✅ - Endoderm of Foramen caecumThe frequency of autosomal recessive disease in a
population is 1/1600. A deletion has been identified that accounts for 80% of mutations at
this locus. 20% of mutations result in point mutations. Frequency of deletion carriers in the
population is closest which of the following?
A 62-year-old woman - progressive bilateral lower abdominal pain and distention. Pelvic
exam shows adnexal mass. Malignant cells. Paclitaxel is initiated. Treatment targets which
in tumor?
✅ - B- Tubulin
hyperstabilizes polymerized microtubules (made up of alpha- and beta- tubulin)
Taxes Stabilize society
The frequency of autosomal recessive disease in a population is 1/1600. A deletion has
been identified that accounts for 80% of mutations at this locus. 20% of mutations result in
point mutations. Frequency of deletion carriers in the population is closest which of the
following?
✅ - 1/25
=sqrt(1/1600) = 1/40
(1/40)*80% = .02
2* 1* .02 = .04 = 1/25
A 46 y/o has dyspnea, orthopnea, midsystolic murmur best heard over the cardiac apex. An
ECG shows a left atrial abnormality. Echo shows enlarged left atrium and normal sized
ventricles. Which findings?
✅ - Mitral Regurgitation
A 19-year-old woman - refractory pustular acne - unresponsive to several topical and
systemic therapies. Treatment with isotretinoin. Which of the following pharmacologic
effects is dependent on binding to the RXR receptor?
✅ - Teratogenic effects in the embryo
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