NBME CBSE ACTUAL TEST QUESTIONS AND ANSWERS (QUIZ BANK WITH ALL THE CORRECT ANSWERS) (USMLE STEP 1) MEDICAL EXAMINATION

1.62-year-old woman - osteoporosis – a bisphosphonate is prescribed. The expected beneficial effect of 

the drug is due to which of the following?

Decreased Osteoclast Activity

2. 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?

Statistically Significant Overall Increase Risk

3.52-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?

Increased nitric oxide concentration

4.24-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?

a. Vascular Endothelial Growth Factor

VEGF – stimulates angiogenesiss.

TYPE III Collagen = Blood Vessels – early wound repair

5.27-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?

a. Adenylyl Cyclase

Adenylate Cyclase – ATP – CAMP -- PROTEKINASE A -- Ca

v2

6.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 infectious agent most likely has which of the following properties?

Mediation of Cell Entry via a fusion protein

7. 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?

B2- Agonist

8. 14-year-old boy - 2-day history of sore throat and fever that peaks in late afternoon. 1 week of fatigue. 

He recently had sex with one partner. Physical exam shows cervical lymphadenopathy and pharyngeal 

erythema with a creamy exudate. DX?

Infectious Mononucleosis

9. 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?

G1

10. 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?

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?

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?

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?

Hemopneumpothorax under tension

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?

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?

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?

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?

Apoptosis