NBME CBSE REAL EXAM 200 QUESTIONS AND ANSWERS LATEST (usmle step 1)MEDICAL EXAMINATION 2024-2025
70yo M dies in a motor vehicle collision. Was undergoing evaluation for occult blood in the stool. Photo of transverse colon shown. Dx?
38yo M truck driver with 1-week hx of watery, itchy eyes and a runny nose. Physical shows inflamed nasal mucosa. No congestion in lower lung. Pharmacotherapy?
16yo girl with 3-day hx of fever, nonproductive cough, and fatigue. T 38.3, P 88/min, BP 102-70. PE shows pale conjunctivae. CXR shows bilateral interstitial infiltrates. Blood spontaenously agglutinates while awaiting transport to the laboratory. Antibody isotypes causing agglutination?
24yo M with small tender blisters on his penis 3 days after unprotected sex. Photograph shown. Causal agent?
53yo M returned from Africa, has fever, headache, and abdominal discomfort. Received appropriate vaccinations prior to the trip. T 39.4C. A wright-stained peripheral smear shown (ring forms in RBCs). Dx?
68yo F with T2DM and hypertension that has been poorly controlled despite hydrochlorothiazide treatment. BP 150/96, Labs show serum glucose concentration of 130 and proteinuria. In addition to current Rx, which is most appropriate pharmacotherapy?
66yo M with stage IV colon cancer with 3-day hx of severe diarrhea after receiving chemotherapy with flourouracil, leucovorin, and irinotecan. Prescribed opioid antidiarrheal agent with no CNS effects. Which med?
59yo F with gradual onset of lack of muscle control in her left arm and leg. Sx 1 mo ago after dx with metastatic breast cancer. PE shows ataxia of left upper and lower extremities. Muscle strength, DTR, sensation, proprioception normal. Metastatic tumor in which location?
Newborn delivered at 38 weeks’ gestation weighs 1800 g. PE shows petechial rash, microcephaly, and hepatosplenomegaly. Serologic test for CMV: IgG + in mother, + in newborn; IGM – in mother, + in newborn. Explanation?
64yo M in ED 3 hours after SOB with exertion and extreme fatigue. Has ischemic heart disease. P 125/min, BP 105/60. ECG shows atrial fibrillation. Intravenous ibutilide is administered. Ten minutes later, ECG shows normal sinus rhythm. Risk for which drug effect in the next 6 hours?
65yo F with 20-year hx of osteoarthritis of the hands now has pain radiating down the distal anterior thigh, knee, medial leg, and food. Bony outgrowth of vertebrae compressing one of the spinal nerves is suspected. Nerve root in which intervertebral foramina is effected?
24yo M with 2-day history of an itchy rash on his arms and legs. Returned from a camping trip in the woods 5 days ago. PE shows edematous, erythematous rash with linear vesicles. Cause is activation of which cell types?
70yo M from china with poorly differentiated monoclonal carcinoma of the nasopharynx. DNA probes of neoplastic cells are most likely to detect genome of which virus?
Compound is taken up by bacterial cells. No energy is necessary for uptake, and the compound is not concentrated in the cell. Which describes this mechanism of transport?
Newborn has male genital ducts but female external genitalia. Cytogenetic analysis shows a 46,XY karyotype, and genetic testing shows a mutation of the gene encoding 5alpha-reductase. In absence of this mutation, labia majora would have been?
Corresponded to penis shaft?
Study designed to evaluate the efficacy of coenzyme Q10 in improving cardiac output in patients with CHF. Sixty patients with CHF are recruited. Each assigned by coin toss to one of tw groups. Design?
12yo boy immersed up to his neck in 60F water for 20 minutes. Physiological changes?\nADH:\nCentral Blood volume:\nANP:
18mo girl. Separation of the umbilical cord was delayed after birth. Has had four severe skin infections Staphylococcus aureus; No pus formation at infection sites. Persistent leukocytosis in absence of infection. Mechanisms impaired?
32yo M with 6-month hx of low back pain and stiffness, worse in morning and improve during the day; the pain radiates to his buttocks but not down his legs. Back stiffness if he sits for prolonged periods. Which to confirm diagnosis?
17yo boy with 8-kg weight gain during the past year. No medical illness. BMI is 32. He asks, \Do you think that my weight gain is inherited from my father?\” Appropriate response?”
52yo M neighbors have reported that he has been confused and not taking care of himself. 4-mo Hx of diarrhea. PE shows extreme muscle wasting, stomatitis, and a diffuse rash that is worse in sun-exposed areas. Diagnosis?
80yo F with suspected temporal arteritis (TA). ESR is 100, Pretest probability for TA is 50% in this patient. In the evaluation of TA, ESR has a sensitivity of 99% and specificity of 60%. Based on the results of the ESR testing, most appropriate next step?
Sequence surrounding the first two exons of the human beta-globin gene shown, with exons in bold. Translation start codon is underlined. A mutation from G–>A at position 355 is most likely to lead to beta-thalassemia by which mechanism?
65yo M emigrated from Brazil with 8-month history of shortness of breath and fatigue, edema of lower ext. CXR shows cardiomegaly. endomyocardial biopsy specimen shows myofiber necrosis with a mixed inflammatory infiltrate of PMNs, T lymphos, m.phages, and eosinophils. Causal org?
42yo farmer has a 7-mm red scaly plaque on helical rim of left ear. Photomicrograph shown. Dx?
30yo F training for a marathon, running 20 mild/day. Fasting glucose is 60. After her glucose stores have been depleted, which organ, in addition to liver, releases glucose?
Male newborn at 28 weeks’. Given ventilatory support with up to 80% oxygen for the next 72 hours, but dies of resp. failure. Cause is inadequate secretion from which labeled cell types?
9yo girl with poor growth during the past year. < 3rd %ile for height and at 10th percentile for weight. PE normal. Visual field testing shows bitemporal hemianoia. Labs show GH deficiency. MRI shows calcified cystic mass in suprasellar region. Tumor derived from?
28yo F G1P1 with 2-day history of a painful mass in her right breast. Delivered healthy female newborn 3 weeks ago, and been breast0-feeding since. T 37C, PE shows 3-cm tender mass surrounded by an area of erythema beneath the right areola. Causal org?
3yo boy with bacterial colitis caused by Salmonella enterica serovar arizonae. Which factor accounts for recruitment of PMNS to inflammatory site by intestinal epithelial cells?
27yo F with fever, malaise, abdominal pain, and vaginal d/c for 4 days. LMP 5 days ago. Had ectopic 1 year ago. T 38.3 C, bilateral lower quadrant tenderness with rebound and guarding. Pelvic exam with cervical motion tenderness and bilateral adnexal tenderness WBC 18k. Pregnancy test neg. Dx?
20M with 3-month hx of progressive thirst (drinking a lot of fluids) and urinary frequency during past 3 days. U/A shows specific gravity less than 1.006. Most likely has dysfunction of which endocrine structure?
21yo M in ED with excruciating anal pain for 4 hours. Exam shows 15-mm, blue tinged rounded mass at anal margin. Represents thrombus in a tributary of which blood vessel?
6-week-old girl with 6-day hx of vomiting small amount of milk 2 to 3 times daily. 50 %ile for length and weight. Cause?
28yo M in ED 30 minutes after SOB. 3-year hx of cocaine abuse. T 38.1, P 100/min, BP 150/45. PE: diminished pulses in left upper extremity. Crackles heard over all lung fields. 2/6 diastolic murmur at left sternal border. CXr shows a widened aortic arch. Dx?
1-week-old girl. screening showed a possible defect in fatty acid oxidation. PE normal. Next step?
79yoM 30 minutes after LOC for 30 seconds. Alert, but dizzy. No urinary or fecal incontinence. Pulse 40/min, BP 92/56. PE shows no tongue biting. Lungs clear, Variable intensity S1. Oriented X3. ECG shows a third-degree atrioventricular block. Next step?
55yo M with chronic bronchitis in ED after being unresponsive. Found bottles of albuterol, ampicillin, codeine, and theophylline bedside. T 37.2 C, p 112/min, respirations are 6/min, BP 95/60. Acute Rx should include?
Physician sad to inform patient of progression of carcinoma to the terminal phase. Physician’s face makes patient cry and ask, \It’s bad news
75yo man 2-year history of decreased force of urinary stream, urinate several times throughout night. BUN 55, Cr 5.0. Ultrasound shows bilateral hydronephrosis and dilated ureter. Mechanism of renal failure?
4yo boy two bacterial urinary tract infections past year. Physical exam normal. Radiologic studies show dilation of left ureter and renal pelvis, minimal left-sided renal function. Left nephrectomy done. Photo: dilated renal pelvis and ureter. Which is cause of renal disease?
3yo boy sickle cell disease with fever and pain over left foot 3 weeks. Hematocrit stable. Leukocyte count 15,000 predominance of neutrophils. Which is most likely explanation for findings?
10yo girl well-child examination. No menstrual period. 50th percentile height and weight. Physical exam absence of breast bud development and no pubic or axillary hair. It is most appropriate to tell mother that first objective sign of puberty will be which?
30yo woman 20 weeks gestation, uncomplicated pregnancy. Fundal height is greater than expected for gestational age. Ultrasound shows increased amniotic fluid. Which abnormality is cause?
43yo woman for health maintenance exam. Physician 30 minutes late for appointment because of emergency, when enters, patients checks watch. Which is best initial response?
27yo woman 12-hour history of fever and abdominal pain. History of recurrent urinary tract infections. Temperature is 39 C (102.2 F). Physical exam tenderness of right flank. Abdominal xrays bilateral staghorn renal calculi. Urinalysis pH 8, many RBCs, WBC, bacteria. Calculi composed of?
48yo nulligravid woman with excessive uterine bleeding for 3 months. Bleeding during menses and at irregular intervals. Menses were regular before. BMI 27. Pelvic exam: adnexae are nonpalpable. Endometrial curettage shows abundant tissue. Which is cause of symptoms?
65yo woman surgical repair of aneurysm right internal carotid artery in cavernous sinus. Three days later, physical exam right pupil larger than left pupil. Weakness of eye movement. Diagram of coronal section through middle cranial fossa shown. Which nerve is damaged?
80yo man type 2 diabetes 2-month history severe constipation. Laxatives haven’t relieved symptoms. Abdominal exam shows distention. Colonoscopy shows no abnormalities. Patient has dysfunction of which nerve?
34yo man lightheaded after running 12 miles of marathon hot day. Pulse 130 bp 80/60. Which changes to autonomic nervous system occurred?
Ten human subjects given new oral drug to monitor drug effect and toxicity. Blood analyzed for human pharmacokinetics of drug for first time. Which trial type?
15yo girl health maintenance exam. Mother dx squamous cell carcinoma face, maternal grandfather died of metastatic melanoma. In patient this age, which factor most predicts compliance with photoprotection?
34yo AIDS patient with pulmonary tuberculosis. No CD4+ T lymphocytes in peripheral blood. Which cellular components most likely to have deficient function in tuberculous lesions in lungs?
25yo woman 6-month history of joint pain poorly responsive to aspirin. Physical exam: bilateral swelling of proximal interphalangeal joints, metacarpophalangeal joints, and wrists; weakness of grasp. Small nodules palpated beneath skin around joints of fingers. Dx?
50yo woman 1-year hx of hot flashes and irregular menses. Decreased bone mineral density. Alendronate prescribed. Mechanism of drug?
65yo women progressive vulvar itching past 2 months; miconazole for yeast infections ineffective. Exam: atrophy of labia minora and thin, parchment-like skin over vulva and anus. Dx?
75yo man 2-day ear ringing, nausea, fatigue. Temp 37 C (98.6 F), pulse 100, respirations 24, bp 140/85. Physical: mild epigastic tenderness. ABG pH 7.42 pCO2 30 pO2 95 HCO3 19. Dx?
15yo girl 1-day hx redness and painful skin following sunbathing. She used sunblock. No medications. Physical exam: severe erythema of back and extremities, no blisters. Dx?
58yo man supraventricular tachyarrhythmia refractory to pharmacotherapy gets ablation of accessory excitatory pathway in atrial endocardium. Which area should be avoided to leave sinoatrial (pacemaker) node intact?
81yo woman massive pulmonary embolism from deep venous thrombosis. Platelet count 160,000. Appropriate pharmacotherapy is started. One week later, platelets 55,000. Thrombocytopenia most likely caused by a drug with which of the following mechanism of action?
35yo woman abnormal Pap smear. Cervical biopsy shows microinvasive cervical carcinoma. Which microscopic features led to dx?
16yo boy with no signs of puberty. Sex development Tanner stage 2. Physical exam: circumcised penis, soft small tests 5 mL, prostate firm, nontender, no discharge or lesions. Testosterone low. Which hormone is cause of decreased serum testosterone and lack of pituitary hormone stimulus?
28yo woman wants to lose weight. She binges on high-carbohydrate foods 2 to 3 times a week, forcing herself to vomit after. BMI 23. Which physical finding is likely?
15yo girl emigrated from India and with several lesions on neck for 2 weeks. Physical exam shows hypopigmented, hypoesthetic area on left side of forehead and 4-cm lesions on neck. Biopsy shows acid-fast bacilli. Best explanation why the organism results in dermal rather than visceral infections?
59yo man has total thyroidectomy for 4-cm follicular carcinoma of thyroid. Twelve hours after procedure, has paresthesias of hands and feet. Vitals stable, carpal spasm on inflamation of bp cuff. Lab findings?
41yo man with asthma and allergy to grass pollen wheezes and difficulty breathing 10 min after mowing lawn. Drug for immediate relief of acute symptoms?
40yo African American woman 2-week hx fever, malaise, dyspnea. Temperature 36.7 C (98 F), respirations 20. Physical exam: erythema nodosum, parotid enlargement, hepatosplenomegaly. Calcium 16. CT chest bilateral hilar adenopathy. Increased in which in serum?
56yo woman with restrictive cardiomyopathy, proteinuria, renal failure. 35-year history of rheumatoid arthritis. Renal biopsy shows glomerular deposition of eosinophilic hyaline material. Congo red statin: birefringent pattern under polarized light. Structure of material?
63yo man 3-month hx difficulty sleeping. Sleeps better upright. HR 90, bp 110/60. Physical exam: increased jugular venous pressure, mild ankle edema. Cause of edema?
14yo boy come to ER 1 hour after colliding with teammate playing soccer. Physical exam: edematous tissues of left eye, mild depression of left zygomatic bone. Skin between eye and upper lip numb. Double vision look upward. Nerve damaged causing sensory loss?
35yo man increasingly depressed, impulsive and difficult over past year. Grimaces intermittently with rapid, jerking, purposeless movements of fingers. Historical factor relevant in dx?
18yo man Crohn disease 1-day hx severe abdominal pain and intermittent bloody diarrhea. Temperature 38 C (100.4 F), pulse 98, respirations 18. Physical exam: draining anal fisutla. Treatment with antibiotics and prednisone over next 3 weeks recovers. Mechanism of pharmacotherapy is suppression of which?
34yo woman with pyelonephritis treated with bactericidal antibiotic 4 days no improvement. Antibiotic added that inhibits binding to 30S ribosome, blocking protein synthesis intracellularly. Antibiotic?
3yo boy and his 5yo brother with recurrent hemarthroses. Both parents healthy, but mother with two younger brothers with same sx and maternal uncle who died at 8 of mild head trauma. Partial thromboplastin time is prolonged. Defect?