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NBME Form 18 Block 1

A 63-year-old man is brought to the physician because of a 2-week history of a sensation of fullness in the left upper quadrant of the abdomen He also has had lethargy and occasional shortness of breath during this period, He has a 9-kg (20-1b) weight loss during the past 3 months. Physical examination shows pallor. The spleen tip is palpated, Laboratory studies show:

Hemoglobin          9g/dL
Hematocrit            27%
Leukocyte count  4000/mm3
Serum uric acid  15 mg/dl

A peripheral blood smear shows numerous erythrocytes with abnormal shapes and sizes, nucleated erythrocytes, and myelocytes. Aspiration of bone marrow results a dry tap. A bone marrow biopsy specimen shows markedly thickened bony trabeculae with increased reticulum. Which of the following is the most likely diagnosis?

A) Acute myeloid leukemia
B) Chronic myeloid leukemia
C) Dysmyelopoietic syndrome
D) Essential thrombocythemia
E) Myelofibrosis
F) Polycythemia vera

A 4-year-old boy (III - 2 in the pedigree) has had a clumsy gait for the past year. Examination shows calf hypertrophy and proximal muscle weakness. Serum creatine kinase activity is increased. Muscle biopsy shows loss of muscle tissue, regenerating muscle fibers, and fibrosis. A maternal uncle (II - 3) had similar findings and died at age 15. The patient’s 20-year-old Sister (III-1) is pregnant; ultrasonography identifies a mate fetus. Which of the following is the probability that this male fetus has inherited this disorder?
A 4 year old boy with Clumsy gait
A)     0
B)     1/8
C)     ¼
D)    ½
E)     ¾

A previously healthy 65-year - old woman comes to the emergency department because of a 6 - hour history of fever and shaking chills. Four hours ago, she took four 325-mg aspirin tablets the fever. Her temperature is 39.4oC (103oF), pulse IS 96/min, respirations are 18/min, and blood pressure is 102/60 mmHg. Physical examination shows marked tenderness bilaterally in the costovertebral areas. Laboratory studies show:

Hemoglobin 13g/dl
Hematocrit 39%
Leukocyte count 32,000/mm3

pH 6
Nitrites 4+
Leukocyte esterase 4+
A photomicrograph of a Wright-stained peripheral blood
A photomicrograph of a Wright-stained peripheral blood is shown. Which of the following is the most likely cause of this patients leukocytosis?

A) Allergic reaction to aspirin
B) Chronic myelogenous leukemia
C) Inappropriate secretion of ADH (vasopressin)
D) Leukemoid reaction
E) Myelodysplasia

A I-year-old boy is brought to the physician by his mother because Of a rash for the past 2 weeks. He is at the 10th percentile for length and weight. Physical examination shows a scaly, seborrheic eruption over the scalp, palms, back, diaper region, and soles of the feet. There IS also generalized lymphadenopathy and hepatosplenomegaly. X-rays of the skull show a few osteolytic lesions. Electron microscopy of a biopsy specimen of a skin lesion shows a tennis racket-shaped bilamellar granule In the cytoplasm of cells. Immunohistochemical studies of the abnormal cells show CD1a antigen expression. The abnormal Cells In this patient are most likely derived from which of the following?

A) Dendritic cells
B) Keratinocytes
C) Mast cells
D) Merkel cells
E) T lymphocytes

A 2-month-old boy is brought to the physician for a well-child examination. The mother has no concerns about his growth or breast-feeding habits and says that he has begun to smile. He is at the 25th percentile for length and 30th percentile for weight. Cardiac examination shows a blowing holosystolic murmur heard best over the lower left sternal border. Which of the following is the most likely cause of the cardiac findings in this patient?

A) Coarctation of the aorta
B) Functional murmur
C) Patent ductus arteriosus
D) Patent foramen ovale
E) Ventricular septal detect

A 45.year odd man comes to the physician for an annual health maintenance examination. He is 183 cm (6 ft) tall and weighs 86 kg (190 lb) BMI is 26 kg/m2. A complete blood count shows no abnormalities. The average of two fasting serum lipid studies shows a total cholesterol of 200 mg/dl, HDL-cholesterol of 50 mg/dL, and triglycerides of 550 mg/dL. In addition to suggesting lifestyle changes, it IS most appropriate for the physician to prescribe which of the following drugs?

A) Colestipol
3) Ezetimibe
C) Fenofibrate
D) Orlistat
E) Simvastatin

A 60-year-old man comes to the physician for a routine health maintenance examination. He has had normal blood pressure measurements. His blood pressure today is 170195 mmHg. Physical examination shows no other abnormalities. Serum studies show hypokalemia and metabolic alkalosis. Plasma renin activity and serum aldosterone concentrations are increased. Following the administration of captopril, there is a marked increase in plasma renin activity. Which of the following IS the most likely cause of the findings In this patient?

A) Aldosterone-secreting adrenal tumor
8) Chronic glomerulonephritis
C) Cushing syndrome
D) Essential hypertension
E) Renal artery stenosis

A 19-year-dd woman comes to the physician because of a 2-day history of pain in her left index finger. She injured it during a softball game when catching a ball. Physical examination shows erythema of the left index finger. The patient is unable to flex the distal phalanx when the proximal interphalangeal joint and metacarpophalangeal joints are restrained. Laboratory studies and x-rays of the left hand show no abnormalities. Which of the following structures is most likely injured in this patient?

A) Extensor digitorum indris
B) Extensor digitorum tendon
C) Flexor digitorum profundus tendon
D) Flexor digitorum superficialis tendon
E) Median nerve
F) Ulnar nerve

A 32-year-old man with HIV infection comes to the physician for a follow-up examination. He has been treated with highly active antiretroviral therapy (HAART) for the past 6 years during which time his plasma HIV Viral load has been undetectable. His plasma HIV viral load has now increased, and antiretroviral resistance is suspected. HIV genotype analysis confirms that the virus has resistance mutations. Based on this finding, which of the following are most likely mutated?

A) Capsid and gp120
B) CD4 and CCR5
C) Nef and Vpr
D) Nucleocapsid and gp41
E) Reverse transcriptase and protease
F) Tat and Rev

In a study designed to test the effectiveness Of a new drug in the treatment Of endometriosis, 100 women were randomly assigned to one Of two groups. Forty-eight Of the women receive the new drug and 52 receive standard therapy. The primary purpose of this method of assigning patients to different groups is to create which of the following?

A) Double-blind study
8) Single-blind study
C) Two groups with similar sample size
D) Two groups with similar underlying characteristics

A 35.year old primigravid woman at approximately 36 weeks' gestation comes to the emergency department because Of a 6-hour history Of heavy vaginal bleeding. She has had no prenatal care. Ultrasonography shows that the placenta is located over the cervical os. Attempts to stop the bleeding are unsuccessful, and she undergoes a cesarean delivery. Which of the following is the most likely diagnosis?

A) Abruptio placentae
B) Placenta accreta
C) Placenta percreta
D) Placenta Previa
E) Placental infarction

A 25-year-old man who has a history of facial flushing and rapid heart rate each time he consumes a small amount of alcohol participates in a study of alcohol intolerance. Molecular analysis shows the presence of a lyslne (K487, oriental variant) for glutamate (E487. native variant) substitution in aldehyde dehydrogenase. The kinetic characteristics of the enzyme variants are shown in the table.
Enzyme   Km (NAD+)(uM)  Kcat (min-1)
E487               37                 180
E487             5600                9.5

Based on these findings, which of the following is the most likely cause of this man's condition?

A) Decreased catalytic efficiency of K487
B) Increased catalytic efficiency Of E487
C) Less rapid turnover by E487
D) More rapid turnover by K487
E) Tighter binding of NAD-to K487
F) weaker binding of NAD-to E487

An 82-year-old woman comes to the physician because of constant severe lower abdominal pain and fever for 24 hours. Laparoscopic examination shows severe diverticulosis and perforated diverticulitis. In spite of appropriate therapy, she dies 2 days later. Her liver at autopsy is shown. Which of the following is the primary component of the material shown on the hepatic surface?

A) Collagen, type I
B) Collagen, type III
C) Fibrin
D) Fibronectin
E) Proteoglycans

A 52-year-old man has chronic pancreatitis. Deficiency of which of the following is the most likely cause of this patient's inability to digest triglycerides?

A) Carbonic anhydrase
B) Cholesterol ester hydrolase
C) Colipase
D) Monitor peptide
E) Phospholipase A2

A 17-year-old boy is brought to the physioan by his mother because she is concerned that his puberty is delayed. The mother states, “He is so short. His father is 6 feet 5 inches tall. I don't understand why he has not had his growth spurt." When the mother leaves the room, the patient states, “ I’m fine. I don’t know what's the matter with her. She wants me to be tall like my dad.” The patient is 175 cm (5 ft 9 in) tall and weighs 70 kg (155 1b); BMI is 23 kgm2. Sexual development is Tanner stage 4. In addition to reassuring the mother that her son is fine, which of the following is the most appropriate initial statement by the physician to the mother?

A) "Since your son is fine with his height, you should try to accept him as he is.”
B) "Tell me more about your concerns about your son's height."
C) "We'll do some blood tests just to be sure that all your son's hormone levels are okay "
D) "Your son is average for his height and weight."
E) "Your son is not going to be any taller."

A 68-year-old man comes to the physician because of a 1-month history of light-headedness and tightness in his chest with exertion. He adds that the pain is worse after arguing with his wife, and the symptoms resolve with rest. He has a past history of lower gastrointestinal bleeding, evaluation at that time was negative on upper endoscopy and colonoscopy. His temperature is 37oC (98.6oF), pulse is 85/min, respirations are 15/min, and blood pressure IS 110/75 mmHg Physical examination shows no abnormalities. HIS hemoglobin concentration IS 8.2 g/dL, and hematocrit IS 24%. Test of the stool for occult IS positive. An ECG shows no abnormalities. Repeat colonoscopy snows no abnormalities. Which of the following is the most likely cause of this patient's gastrointestinal symptoms?

A) Adenocarcinoma Of the colon
B) Angiodysplasia
C) Diverticulitis
D) Peutz - Jeghers syndrome
E) Ulcerative colitis
A 58-year-old woman comes to the physician because Of a 6-month history Of Shortness Of breath and chronic nonproductive cough. She a 2-year history Of difficulty swallowing. joint stiffness. and diffuse tightening of the skin of the face, neck, shoulders, arms, and fingers. She has had significant sensitivity to cold weather for 20 years, and she says that her hands turn white when they are exposed to the cold. Current medications include a histamine (H2) blocking agent for a long-standing history of esophageal reflux. One year ago, a biopsy specimen of the skin showed atrophy of the epidermis and deposition of dense collagen throughout the dermis with loss of the dermal appendages. Examination of the hands shows cutaneous ulceration, clawlike flexion deformity, and decreased joint mobility. This patient is at greatest risk for which of the following pulmonary disorders?

A) Adenocarcinoma
B) Bronchiectasis
C) Granulomatous inflammation
D) Panacinar emphysema
E) Pulmonary embolism
F) pulmonary hypertension
G) Squamous cell carcinoma

A 27-year old man comes to the physician for a psychiatric evaluation at the request of his new employer because his coworkers think he is "very odd." He is employed as a computer repair specialist and lives alone. He refuses to socialize with anyone from work, and he has no friends that he sees regularly. He is extremely preoccupied with science fiction, the occult, and the afterlife, although he holds no particular religious beliefs. Which of the following personality disorders is the most likely explanation for his behavior?

A) Antisocial
B) Borderline
C) Narcissistic
D) Paranoid
E) Schizotypal

An 8-month old girl is brought to the physician by her mother because of a 3-week history of poor feeding, chronic diarrhea, and pale, foul-smelling stools. The mother says that the symptoms began with colicky abdominal pain following the introduction of solid food to the Infant's diet. There is a family history of gluten sensitivity. She is at the 60th percentile for length and 25th percentile for weight. Physical examination shows no other abnormalities. Dysfunction of which of the following cells is the most likely cause of this patient’s symptoms?

A) Enterocytes
B) Goblet cells
C) Paneth cells
D) Parietal cells
E) Serosal cells

Following an operation, a 65-year-old patient has a lung region that is under ventilated but well perfused. This condition will lead to an increase in which of the following?

A) Alveolar dead space
B) Anatomic dead space
C) Physiologic dead space
D) Physiologic shunt
E) Po2

A 32-year old woman undergoes an operation after the diagnosis Of hyperparathyroidism IS made. During the operation, three parathyroid glands are found on the posterior surface Of the thyroid gland, but one does not appear in its normal superior location on the right side. Which of the following embryologic events IS the most likely cause of the findings in this patient?

A) Abnormal migration of endoderm from the fourth pharyngeal pouch
B) Absence of inductive factors in occipital somite mesoderm
C) Failure of neural crest cells to migrate through the pharyngeal arches
D) Incomplete formation of the third pharyngeal pouch
E) Premature involution of the thyroglossal duct

A 25-year-old woman comes to the physician for counseling prior to conception. She has seizure disorder well-controlled with valproic acid. She asks the physician if her fetus would be at risk because of her drug therapy. The fetus would be at greatest risk for a drug—related adverse effect at which of the following stages of pregnancy?

A) O to 2 weeks
B) 3 to 8 weeks
C) 9 to 12 weeks
D) 12 to 18 weeks
E) 18 to 24 weeks

A 46-year-old woman comes to the physician because of a 1-week history of low-grade fever and joint pain. She has chronic headaches for which she takes ibuprofen several times daily. Physical examination shows a diffuse maculopapular rash. Urinalysis shows 2+ protein, 10—20 WBC/hpf, and eosinophils. A renal biopsy specimen is most likely to show which of the following in this patient?

A) Crescent-shaped glomeruli
B) Inflammatory infiltrates in the interstitium
C) Mesangial cell proliferation
D) Sclerosed glomeruli
E) Subepithelial deposits in the glomerular capillary walls

A 2-year old boy is brought to the physician because of a 2-day history of fever, sore throat, and rash. His temperature is 38.7oC (101.7oF). There is a widespread, red, sandpaper-like rash over the extremities. A purulent exudate is seen over the tonsils. He receives the diagnosis of Streptococcus pyogenes (group A) infection. Which of the following streptococcal components is the most likely cause of the skin findings in this patient?

A) Capsular polysaccharide
B) Erythrogenic toxin
C) Hemolysin
D) Hyaluronidase
E) Streptolysin S

A 35-year-old woman who is being examined because of infertility receives an injection of contrast material into her cervix to visualize the reproductive tract before undergoing radiographic tests.

On the hysterosalpingogram shown, the contrast material (as indicated by the arrows) is also seen in the peritoneal cavity. Which of the following best explains this finding?

A) Rupture of the fallopian tube
B) Rupture of the uterine body
C) Spillage of contrast, which is an artifact
D) Spillage of contrast, which is normal

A 48-year-old woman has had the gradual onset of back pain over the past 2 weeks. There is no history of trauma. She does not smoke cigarettes, drink alcohol, or use illegal drugs. Hemogram, serologic studies, and urinalysis are unremarkable. An x-ray of the spine shows two lytic lesions, one in T-10 and the other in L-1. Which of the following is the most likely diagnosis?

A) Avascular necrosis
B) Metastatic carcinoma of the breast
C) Osteosarcoma
D) Renal osteodystrophy
E) Thyroid carcinoma

A 47-year old woman develops an irregular, raised, multicolored dark lesion on the area of her left forearm that is frequently exposed to direct sunlight. Examination of tissue obtained on biopsy shows malignant pigmented cells. Involvement of which of the following skin layers is associated with the greatest risk for an unfavorable prognosis?

A) Basement membrane
B) Epidermis
C) Papillary dermis
D) Reticular dermis
E) Subcutaneous tissue

A 6-year-old girl is brouqht to the emergency department by her father because of a 15-minute history of severe shortness of breath. The father says that she was diagnosed with a throat tumor 3 years ago. Her respirations are 32/min. Physical examination shows nasal flaring. Laryngoscopy shows multiple raised, finger-shaped lesions arising from the vocal cords and epiglottis and partially occluding the larynx. The lesions are excised. Microscopic examination of one of the lesions shows finger-shaped fibrovascular cores lined with benign squamous epithelium. Which of the following is the most likely causal virus?

A) Cytomegalovirus
B) Epstein-Barr virus
C) Herpes simplex virus 1
D) Herpes simplex virus 2
E) Human papillomavirus, type 6

A 32-year-old man with an X-linked recessive disease has deafness, hematuria, and progressive renal failure. He most likely has an abnormality in which of the following proteins?

A) Fibrillin
B) Fibronectin
C) Keratin
D) Laminin
E) Osteocalcin
F) Thrombospondin
G) Tropoelastin
H) Type IV collagen

A 25-year-old woman comes to the physician because of a 2-year history of intermittent, diffuse, cramping lower abdominal pain. The pain is usually associated with 2 to 6 days of loose, watery stools, and is typically relieved with defecation. Between these episodes, her stools are normal. Her vital signs are within normal limits. Physical examination shows no abnormalities. Laboratory studies, including complete blood count, metabolic panel, and thyroid function tests show no abnormalities. A drug targeting which of the following mechanisms of action is most appropriate for this patient?

A) Accentuation of bile salt reabsorption
B) Accentuation of µ-opioid myenteric plexus receptor
C) Inhibition of colonic water reabsorption
D) Inhibition of 5-hydroxytryptamine 1 receptor
E) Inhibition of tumor necrosis factor-alpha

A 35-year-old man is brought to the physician by staff of the group home where he resides because of worsening behavior for 2 weeks. During the interview, he tells the physician that he believes the CIA is spying on him through his television set. He then reports hearing voices in the hall outside the examination room and states that the CIA now plans to kill him. He appears disheveled with unkempt hair and poor hygiene. He has difficulty answering the physician's questions because he seems to be listening to internal stimuli. Mental status examination of the patient is most likely to show which of the following findings?

A) Flattened affect
B) Inability to state his name
C) Inability to write his name
D) Lack of orientation to place or time
E) Long-term memory impairment

A 70-year-old woman comes to the physician for a routine pelvic examination During speculum examination of the vagina and cervix, the Valsalva maneuver causes a bulge of the anterior vaginal wall. Which of the following is the most likely cause of this finding?

A) Bartholin gland cyst
B) Cystocele
C) Obturator hernia
D) Rectocele
E) Uterine prolapse

A 45-year-old man comes to the physician because of a 6-month history of progressive shortness of breath with exertion. He has a history of frequent nosebleeds since adolescence. He is 178 cm (5 ft 10 in) tall and weighs 70 kg (175 1b): BMI is 25 kg/m2. Physical examination shows the findings in the photographs.

Inhaled albuterol does not improve his symptoms. Which of the following is the most likely cause of this patient's condition?

A) Atrial septal defect
B) Hypertension
C) Pulmonary arteriovenous shunting
D) Reactive airway disease
E) Thromboembolism

A 68-year old man comes to the physician because of a 10-month history of shortness of breath and swelling of his feet. He has a family history of cardiovascular disease. He has smoked 2 packs of cigarettes daily for 50 years. His pulse is 80/min, respirations are 24/min, and blood pressure is 150/80 mmHg. Physical examination shows 3+ pitting edema of the lower extremities. Diffuse, scattered wheezes are heard bilaterally on auscultation of the chest. Cardiac examination shows a grade 2/6 pansystolic murmur heard best at the lower left sternal border, which increases on Inspiration. The point of maximal impulse is palpated in the sub-xiphoid area. S1 and S2 sounds are distant. Abdominal examination shows a liver span of 14 cm. Which of the following is the most likely diagnosis?

A) Aortic stenosis
B) Cardiac amyloidosis
C) Cor pulmonale
D) Coronary artery disease
E) Primary pulmonary hypertension

A 35-year-old woman comes to the physician because of pain of her left leg for 2 days. Physical examination shows a deep venous thrombosis in the left lower extremity. Laboratory studies show a platelet count of 200,000/mm3, prothrombin time of 12 seconds (INR=1), and partial thromboplastin time of 37 seconds. Treatment with heparin is started. Five days later, physical examination shows no active bleeding. Her platelet count now is 120,000/mm3. Which of the following best explains the decreased platelets in this patient?

A) Antithrombin III deficiency
B) Cold agglutinin disease
C) Disseminated intravascular coagulation
D) Drug - related antibodies
E) Kasabach-Merritt syndrome
F) Migratory thrombophlebitis
G) Splenomegaly
H) Vitamin K deficiency

A 58-year-old man comes to the physician to obtain a prescription for a benzodiazepine because he is experiencing an intolerable situation at work. He says that he needs to work until the age of 60 years before he can retire, but his younger boss is expecting too much of him. He feels anxious and thinks that he can complete his last 2 years of work if he decreases his anxiety. The physician prescribes a 1-month regimen of benzodiazepine therapy and schedules a follow-up appointment. Two weeks later, the patients wife calls and says, "My husband just got fire! I know it's because he was taking too much of that drug you gave him. Didn't you know that he has a long history of alcoholism?” Which of the following IS the most appropriate initial action by the physician?

A) Contact the patient to discuss the situation
B) Contact the risk management department of the medical practice's insurance company regarding a potential claim
C) Discharge the patient from the medical practice for inappropriate use of medication
D) Inform the patient's wife that her information cannot be accepted because of HIPAA
E) Refer the patient to a substance abuse program

A 21-year-old woman comes to the physician because of a 10-day history of difficulty walking. Two years ago, she had loss of vision in the left eye which improved over 2 months. Neurologic examination shows decreased visual acuity in the left eye with pallor of the optic disc. She has past-pointing on a finger-nose test. She has a broad-based gait. An MRI of the brain shows lesions in the white matter of the cerebellum. Which of the following best describes the pathogenesis of the disease process in this patient?

A) Antibodies With specificity for axonal microtubules bind to the surface of axons
B) CD4+ T lymphocytes are activated by myelin basic protein
C) CD8+ T lymphocytes kill astrocytes
D) Complexes of rheumatoid factor and IgG are deposited in the choroid plexus
E) Inflammatory vasculitis affects perforating arterioles

A 27-year-old primigravid woman at 18 weeks' gestation comes to the physician for a routine prenatal examination. The uterus is consistent in size with an 18-week gestation. Ultrasonography shows a male fetus. The collecting system and pelvis of the left kidney is dilated, and the renal cortex appears compressed. The left and right ureters are not dilated. The right kidney appears normal. Amniotic fluid volume is normal. Which of the following is the most likely cause of the renal findings in this patient’s fetus?

A) Abnormal ureteral insertion into the bladder wall
B) Agenesis of the upper urinary tract
C) Congenital urethral structure
D) Ectopic ureter
E) Incomplete recanalization of the proximal ureter
F) Posterior urethral valves

A 33-year-old man comes to the physician for a follow-up examination. He was diagnosed with epilepsy at the age of 10 years. His most recent seizure. which was generalized tonic-clonic, was 5 years ago. At that time, his medication was adjusted. He has no other history of major medical illness and has not had any collisions while driving his personal motor vehicle. Current medications include carbamazepine. His vital signs are within normal limits. Physical examination shows no abnormalities. Which of the following best describes this patient’s status with respect to driving?

A) Determination of his driving status should be deferred until he has undergone an EEG while awake and asleep
B) He is medically qualified to drive
C) He is not medically qualified to drive until 10 years has passed since his last seizure
D) He is not medically qualified to drive while he takes carbamazepine

A 52-year-old woman with breast cancer comes to the physician for a follow-up examination. She had a 4-week course of radiation treatment 6 months ago. Her respirations are 26/min. Physical examination shows no recurrence of the cancer. A CT scan of the chest shows bilateral patches of atelectasis in the upper lung fields. The atelectasis in this patient most likely developed because of which of the following primary pathophysiologic processes?

A) Compression
B) Consolidation
C) Contraction
D) Obstruction
E) Resorption

A 24-year-old man is brought to the physician because of a 3-day history of progressive numbness of both feet that now has ascended to the level of his thighs. In the last 24 hours, he has developed numbness and tingling of his hands. Physical examination shows an ataxic gait. Deep tendon reflexes are diminished in the upper extremities and absent at the knees and ankles. Sensation to vibration and joint position is absent in the fingertips and feet Bilaterally. There is mild weakness of the distal upper extremities and moderate weakness of the lower extremities. A process involving which of the following structures is the most likely explanation for these sensory findings?

A) Dorsal spinocerebellar tract
B) Fasciculus cuneatus
C) Fasciculus gracilis
D) Myelinated primary afferents
E) Unmyelinated primary afferents
F) Ventral spinocerebellar tract

A 25-year-old man who just returned from work as a Peace Corps worker in Africa begins oral chloroquine therapy for malaria caused by Plasmodium vivax. His initial therapeutic response is good, but he develops recurrent parasitemia 2 months later. Which of the following best explains the recurrence?

A) Chloroquine is ineffective as oral therapy for P. vivax malaria
B) Chloroquine is ineffective on the exoerythrocytic malarial tissue stages
C) Chloroquine is only effective against P.vivax when combined with metronidazole
D) The patient has a second previously occult malarial infection
E) The patient is infected with a chloroquine-resistant strain of P. vivax

A 28-year-old woman comes to the physician because of a 4-day history of palpitations, severe neck pain, fatigue, and malaise. Her pulse is 120/min and regular. Physical examination shows a diffuse tender, mildly enlarged thyroid gland. There is no exophthalmos. Serum studies show a thyroid-stimulating hormone concentration of 0.01 µU/mL. Which of the following is the most likely diagnosis?

A) Factitious thyrotoxicosis
8) Graves disease
C) Subacute granulomatous thyroiditis
O) Thyroid abscess
E) Toxic multinodular goiter

A 45-year-old woman comes to the physician because of a 4-month history of joint pain, muscle aches, and fatigue. She was treated for a renal calculus 6 months ago, and she underwent cholecystectomy 1 year ago. She appears fatigued and depressed. Physical examination shows mucosal pallor. All extremities have full range of motion, but movement produces mild pain. No masses are palpated in the neck or abdomen.
Laboratory studies show:

A technetium-99m tetrofosmin scan shows a single 1.2-cm nodule in the neck region. The pathologic process in this patient is most likely initiated by a mutation in which of the following genes?
E) NF1

A 17-year-old boy has septic shock that is unresponsive to intravenous ADH (vasopressin) therapy. This treatment is discontinued, and high-dose dopamine therapy is initiated. Stimulation of which of the following receptors is most likely to be of benefit to this patient?

A) alpha 1-Adrenoreceptors
B) alpha 2-Adrenoreceptors
C) ß1-Adrenoreceptors
D) ß2-Adrenoreceptors
E) D2-receptors

A laboratory technician wipes down the workbench with alcohol after an experiment. This treatment will successfully inactivate viruses with which of the following characteristics?

A) DNA genome
B) Enveloped virion
C) Helical capsid
D) Icosahedral capsid
E) Naked virion
F) RNA genome

A 55-year-old man of northern European descent comes to the physician because Of a 2-month history of weakness, altered skin color, and bilateral knee pain. Two of his siblings have type 2 diabetes mellitus and cirrhosis. Physical examination shows bronzed skin, hepatomegaly, and arthritis of both knees. Serum studies show increased saturation of transferrin and Increased ferritin concentration. A liver biopsy specimen shows increased iron content and cirrhosis. This patient is at greatest risk for which of the following?

A) Basal ganglia atrophy
B) Diabetes insipidus
C) Hepatocellular carcinoma
D) Pigment gallstones
E) Pulmonary fibrosis

A 21 -year-Old man loses 15% Of his total b1ood volume Within 2 minutes after a motor vehicle collision. Which Of the following findings is most likely?

A) Chemoreceptor-mediated vasoconstriction
B) Decreased sympathetic nerve activity to the veins
C) Increased sympathetic nerve traffic to the sinoatrial node
D) Increased tonic release of atrial natriuretic peptide from the atria
E) Increased vagal efferent nerve activity to the sinoatrial node
A 1-year-old girl is brought to the physician for a follow-up examination. She has had numerous infections of the skin and oral mucosa since birth; the infections have been slow to respond to antibiotic therapy. Her temperature is 38oC (100.4oF). Physical examination shows multiple erythematous lesions of the skin, some of which have superficial ulceration. Laboratory studies show a leukocyte count of 21,000/mm3 with 77% segmented neutrophils, 6% bands, 14% lymphocytes, and 3% monocytes. A biopsy of one of the lesions shows no neutrophils within the dermis or epidermis. Culture of the lesion grows Staphylococcus aureus. This patient's recurrent infections are most likely caused by defective production of which of the following?

A) An addressin
B) A component of complement
C) An integrin
D) An interleukin
E) A prostaglandin

A 69-year-old woman comes to the physician because of a 3-week history of muscle cramps, weakness, abdominal pain, and constipation. She has hypertension treated with metoprolol and hydrochlorothiazide for the past 4 months. Laboratory studies show hypokalemia. It is most appropriate for the physician to add which of the following drugs to this patient’s current medication regimen?

A) Bumetanide
B) Chlorthalidone
C) Furosemide
D) Indapamide
E) Triamterene

The Answers are coming soon!!! Feel free to share answers to any number in the comments section.


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manizz (Basic)   2 weeks ago
Thanks for sharing

joshua2006 (Basic)   2 days ago



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  National Board of Medical Examiners Obstetrics & Gynecology Self-Assessment 1. A 32-year-old woman, gravida 5, para 4, at 40 weeks' gest...


NBME form 3 Questions and Answer Obstetrics and Gynecology

1. A 32-year-old primigravid woman comes to the physician at 30 weeks gestation because of a 10-day history of decreased appetite, intermittent nausea...


NBME Surgery Form 4

National Board of Medical Examiners Surgery Self-Assessment 1.Three weeks after undergoing arteriography through the right groin for evaluation of p...



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NBME 24 Block 1.pdf  

NBME 24 Block 1.pdf

NBME Form 24 Block 1

NBME 24 Block 2.pdf  

NBME 24 Block 2.pdf

NBME Form 24 Block 2 for USMLE preparation

NBME 24 Block 3.pdf  

NBME 24 Block 3.pdf

NBME Form 24 Block 3 for USMLE preparations

NBME 24 Block 4.pdf  

NBME 24 Block 4.pdf

NBME Form 24 Block 4 for USMLE preparations

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NBME 1 BLOCK 1-4 .pptx



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