NBME EXAM PREP NEWEST TEST BANK 2

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NBME EXAM PREP NEWEST TEST BANK| 2

VERSIONS (VERSION A & B) EACH VERSION

WITH 450 QUESTIONS AND CORRECT

DETAILED ANSWERS (VERIFIED ANSWERS)

ALREADY GRADED A+| NBME EXAM REVIEW||

BRAND NEW!!

Newborn baby with machine-like murmur along sternal border, increased precordial activity, and bounding peripheral pulses. What enzyme does the treatment block? - ANSWER - Cyclooxygenase

• treat with indomethacin (NSAID)

woman with invasive squamous cell carcinoma of cervix from HPV 16.What cells recognize and kill these virus infected tumor cells? - ANSWER - T lymphocytes

Boy w/ mental retardation and obese with Prader-Willi syndrome has karyotyping and fluorescent in situ hybridization. There is no usual deletion in chrom 15. What is another way this child may have this disorder? - ANSWER - Maternal origin of both chromosomes 15

• 75% is from a paternal gene that is inappropriately silenced
• 25% is from inheriting two maternal chrom that are not meant to be

imprinted (silenced) so the child is left with no chrom 15

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pg. 2 56 yo woman frequently burns herself, loss of pain/temperature in both upper extremities. Touch, vibratory sensation and proprioception are normal. What will be on an MRI? - ANSWER - Syrinx of the central region of the spinal cord from c4-T5

• cystic cavity blocks anterior white commisures (decussation of the

spinothalamic tracts)

• "cape like" loss of pain and temperature
• associated with chiari I malformations or from trauma

What cells in the kidney are the first to show anoxic injury? - ANSWER

• Proximal tubule

85 yo woman with broken femur started on morphine. Three days later has low respirations (6/min), pinpoint pupils, and serum creatinine is

1.8. Why? - ANSWER - Morphine is metabolized to active metabolites

that accumulate and are excreted by the kidneys causing toxicity

How does smoking affect the mucus production and secretion, activity of cilia, and alveolar macrophage function? - ANSWER - Mucus production and secretion increases (increase in goblet size/function) -> this mucus remains stagnant as the mucociliary escalator is slowed down and eventually depleted with prolonged smoking.

• Alveolar macrophage function decreases

A girl chips her tooth and inhales it. Where will it most likely aspirate it?

• ANSWER - Right lower lobe
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pg. 3 33 yo with muscle weakness, cramping beginning after exercise. He has high serum creatine kinase. After exercising forearm, vein sample shows lactate concentrations do not increase. What deficiency does he have? - ANSWER - glycogen phosphorylase

• McArdle Disease = muscle disease
• increased glycogen in muscle cannot break it down = painful muscle

cramps

• blood glucose levels unaffected

16 yo girl with cystic fibrosis, weakness, numbness, and tingling of arms and legs, difficulty walking with ataxic gait. Non-adherent medication.What is she deficient in? - ANSWER - Vitamin E

• CF -> dysfunction of exocrine pancreas -> malabsorption of fat soluble

vitamins (DEAK)

• looks like vitamin B12 deficiency, but no megaloblastic anemia,

hypersegmented neutrophils or increased serum methylmalonic acid (which is normal in folate acid def too)

29 yo woman wanting to lose weight takes thyroxine exogenously from a friend with a prescription. Her thyroid function is normal. What will her thyroid gland look like after several months? - ANSWER - She will have follicular atrophy

• as you are providing the end product of the HPA axis, the T3,4 will

provide NFB on the hypothalamus (no more TRH) and anterior pituitary (no more TSH) gland which will decrease production of endogenous T3,4 in the follicular cells of the thyroid

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pg. 4 56 yo man with rotator cuff injury underwent operation. to strengthen his infraspinatus and teres minor what movements should he perform against resistance? - ANSWER - Lateral (external) rotation

• infraspinatus -> suprascapular nerve
• teres minor -> axillary nerve

Medial (internal) rotation and adduction

• subscapularis -> subscapular nerves

abducts arm first 15 degrees

• supraspinatus -> suprascapular nerve
• most common rotator cuff injury

57 yo man w/ 6 months of constipation and rectal fullness, DRE no palpable lesion. Stool occult blood = positive and colonoscopy shows mass in sigmoid colon w/ adenocarcinoma on Bx. Which lymph nodes will this initially spread to? - ANSWER - inferior mesenteric

• follow vasculature

30 yo woman with Li-Fraumeni syndrome has adenocarcinoma of the breast. What mechanism underlies this condition? - ANSWER - Impaired regulation of apoptosis

• P53 = tumor supressor genes, the traffic cops of the cell cycle
• prevent progression from G1-> S phase until DNA is either repaired (if

possible), or they call in factors (BAX) to undergo apoptosis

• activates P21

- Li-Fraumeni: AD, multiple malignancies at early age -> SBLA

(sarcoma, breast, leukemia, adrenal gland)

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