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... pgayed made a comment on nbme19#4 (66 yo man, 2 months no erection)

 +12  upvote downvote
submitted by pgayed

Inability to maintain an erection = erectile dysfunction. So now the question is "Why?"

Fatigue, difficulty sleeping, difficulty concentrating is starting to sound like depression. "Difficulty concentrating" might be interpreted as impaired executive function or the beginnings of vascular-related dementia (dementia related to small but numerous cerebral infarcts), but on Step 1 dementia will be blatant (i.e., "lost his way home," "wandering," etc.).

Depression is actually common after a debilitating event like stroke, as you might expect. With depression comes a loss of sexual interest and desire—that is decreased libido.

One can make the argument that a "vascular patient" might have some issues with his "pipes" (arteriosclerosis, parasympathetic/sympathetic dysfunction) and, for this reason, nocturnal erection should be decreased; but note that nothing is mentioned about long-standing vascular disease (no hx of hypertension).

As a result, the best answer choice here is C. (Libido decreased but nocturnal erections normal.) The big question I have is, how the heck does this guy know he's hard when he's asleep!!? :p


... mtthwgyd made a comment on nbme19#35 (5 yo boy, right eye pain 1 week)

 +4  upvote downvote
submitted by mtthwgyd

This is what is known as a somatic mutation: a mutation that occurs in non-germline cells and, therefore, only effects daughter cells derived from the parent cell with the mutation. So, a mutation occurred in a differentiated parent cell that gave rise to a set of daughter cells (which, in this case, were destined to become retinal tissue).




NBME 19

Block 1/Question#1
53 yo woman with GERD.
Omeprazole


Block 1/Question#4
66 yo man, 2 months no erection
Libido: decreased; Noctural erections: normal


Block 1/Question#7
48 yo woman, 2 weeks fever and mucus in stool
Entamoeba histolytica


Block 1/Question#13
Mechanism of action of tumor suppressor genes
Inhibition of cell-cycle regulation


Block 1/Question#16
60 yo man, 2 weeks flank pain and blood in urine
Metastatic renal cell carcinoma


Block 1/Question#17
29 yo man untreated HIV
CD8+ T lymphocyte–mediated killing


Block 1/Question#24
62 yo woman sudden weakness of left leg
Right anterior cerebral artery


Block 1/Question#26
Niemann-Pick
Decreased lysosomal hydrolase activity


Block 1/Question#28
13 yo girl with mother for routine visit
Ask mother to leave the room before asking the patient any questions.


Block 1/Question#31
32 yo man on primaquine
Enzyme deficiency in the erythrocytes


Block 1/Question#34
12 yo girl, 5 days unable to walk but unconcerned
Conversion disorder


Block 1/Question#35
5 yo boy, right eye pain 1 week
Retinal cells


Block 1/Question#36
36 yo woman believes she had a heart attack
Panic disorder


Block 1/Question#42
Advantage of randomized controlled studies
Better control for confounding variables


Block 1/Question#44
Best testing strategy when treatment has serious side effects
Test 3 followed by test 1 if test 3 is positive


Block 1/Question#48
62 yo man, decreased speech fluency after cerebral infarct
Area labeled by letter 'A'


Block 2/Question#5
38 yo woman, 6 months depressed mood, joint pain, weakness, memory problems + erythema migrans
Lyme disease


Block 2/Question#6
24 yo man, generalized tonic-clonic seizure; somnolent, hyponatremia; drinks 6 liters of water in 24 hours but says he's not thirsty
Psychogenic polydipsia


Block 2/Question#8
Retinoic acid receptors and HOX gene products bind specific DNA sequences; what is the function of these molecules?
Transcription factors


Block 2/Question#9
Lab findings expected after administration of insulin and saline
Potassium decreased; Bicarbonate increased; BUN decreased; Arterial pH increased; blood CO2 increased


Block 2/Question#13
25 yo man, exercise test. Most likely physiologic changes
Arteriolar diameter increased; Tissue adenosine concentration increased; Vascular conductance increased


Block 2/Question#16
40 yo woman, chorionic villus sampling
Confined placental mosaicism


Block 2/Question#17
Scurvy symptoms associated with decreased activity of which enzyme?
Prolyl hydroxylase


Block 2/Question#23
10 yo girl, slightly painful 2 mm subcutaneous nodule on chin
Granuloma


Block 2/Question#25
48 yo woman, 3 months fatigue; X-rays reveal generalized osteopenia
Paracrine stimulation of osteoclasts by osteoblasts


Block 2/Question#27
Case-control study; 95 percent confidence interval was [reported range]. Most appropriate interpretation?
The likelihood is 95% that the true value for the odds ratio is between [the reported range]


Block 2/Question#34
Mechanism by which action potentials permit currents to flow deep within skeletal muscle fibers
Transmission along T tubules


Block 2/Question#36
75 yo man with dementia; no advanced directives
Encourage the family to come to a consensus based on their perception of the patient's wishes


Block 2/Question#37
2 day old newborn with jaundice
Conjugation of bilirubin to glucuronic acid


Block 2/Question#43
45 yo woman undergoing vinblastine chemotherapy
Decreased number of neutrophils


Block 2/Question#45
Pathway of the transepithelial transport of water
Pathway denoted by letter 'C'


Block 2/Question#46
Decreased pulmonary artery pressure facilitated by increase in the intracellular concentration of which molecule?
cGMP


Block 3/Question#5
30 yo woman, 1 week of visual difficulty
Right optic nerve


Block 3/Question#9
Cells most responsible for graft rejection?
T lymphocytes


Block 3/Question#12
23 yo woman engages in 30 minutes of strenuous exercise
Increased, as a result of distention and recruitment of microvessels


Block 3/Question#16
13 yo girl grows over the summer; what accounts for increased intestinal absorption of calcium?
Hormones derived from 7-dehydrocholesterol


Block 3/Question#17
45 yo patient, chronic alcohol dependence, foul-smelling brownish sputum
Chest radiograph labeled 'D'


Block 3/Question#19
30 yo man and 24 yo woman; best estimate that child will have oculocutaneous albinism?
1 in 600


Block 3/Question#22
Blood gas values: arterial O2 pressure: 96 mm Hg; Arterial O2 content: 12.0 vol%
Anemia


Block 3/Question#27
74 yo man; continuous systolic-diastolic bruit over R posterior flank
Renal artery stenosis


Block 3/Question#28
40 yo man, 1 month increasing malaise, nausea, abdominal pain; CD8+ T lymphocytes resulting in liver injury
Hepatocytes


Block 3/Question#29
15 yo girl receives bone marrow transplant; karyotype reveals 46,XY
Nonautologous donor


Block 3/Question#33
19 yo man stabbed in abdomen; has been incarcerated for armed robbery
Antisocial personality disorder


Block 3/Question#34
52 yo man, 4 hours of severe headache, anxiety, sweating, palpitations; what happens after injection with propranolol?
Increased total peripheral resistance and decreased cardiac output


Block 3/Question#39
45 yo man, lost outdoors in the Rocky Mountains for 10 days
Kidney


Block 3/Question#40
25 yo woman requests prenatal diagnosis at 12 weeks gestation
Chorionic villi sampling


Block 3/Question#41
41 yo woman, 34 weeks gestation; amniocentesis shows lecithin-to-sphingomyelin ratio of 1.5:1
Decreased functional residual capacity


Block 3/Question#42
Study conducted to determine effects of drug X on respiratory function
Tubocurarine


Block 3/Question#46
52 yo man, sudden onset of substernal chest pain
Histamine


Block 3/Question#49
Schematic representation of eukaryotic translation
Binding of aminoacyl-tRNA to the A site


Block 3/Question#50
39 yo man, 6 months of headache, muscle aches, fatigue; distal motor weakness of extremities
Basophilic stippling


Block 4/Question#13
26 yo woman after jejunoileal bypass for morbid obesity; most likely deficiency?
Vitamin A


Block 4/Question#14
11 yo boy, right mid-thigh pain for 2 weeks; femur X-ray reveals single osteolytic lesion in mid-diaphysis
Ewing sarcoma


Block 4/Question#15
60 yo woman, 1 year of episodic involuntary rhythmic jerking of R leg and foot; brain MRI reveals 2 cm round enhancing lesion within interhemispheric fissure
Meningioma


Block 4/Question#17
60 yo man, 20-year history of hypertension; shortness of breath and fatigue for 3 months
Cardiac output: decreased; CVP: increased


Block 4/Question#23
30 yo woman with Marfan syndrome, sudden onset of tearing chest pain
Cardiac index: 2.0;
Right atrial pressure: 18;
Pulmonary capillary wedge pressure: 18;
Pulmonary diastolic arterial pressure: 20;
Systemic vascular resistance: 2,000



Block 4/Question#26
54 yo man, routine exam; given an angiotensin converting enzyme (ACE) inhibitor
Area labeled by letter 'F' (efferent arteriole)


Block 4/Question#27
52 yo woman prescribed cisplatin for non-small cell carcinoma of the lung
Odansetron


Block 4/Question#33
Oral fluid therapy for diarrhea caused by Vibrio cholerae
Membrane transport mechanism denoted by letter 'C' (Sodium-Glucose cotransporter)


Block 4/Question#46
24 yo woman; renal oxygen consumption found to be 20 mL per minute; which process consumes the most oxygen?
Tubular reabsorption


Block 4/Question#49
30 yo woman with high-grade intraepithelial lesion
Superficial to the basement membrane


NBME 18

Block 1/Question#3
5 yo boy, history of motion sickness
Antagonist at muscarinic-3 receptors


Block 1/Question#10
25 yo woman, polycystic kidneys
HCO3: decreased; inorganic PO4: increased; parathryroid hormone: increased


Block 1/Question#11
67 yo man, fine resting tremor in both hands
Alpha-synuclein


Block 1/Question#13
10 yo boy, nosebleeds and easy bruising
Antibodies directed against the glycoprotein (Gp) IIb/IIIa complex


Block 1/Question#14
26 yo man with 27 yo wife, inability to conceive
Primary spermatocyte


Block 1/Question#15
experimental animal with defect in an innate gastrointestinal defence mechanism
Chronic gastritis


Block 1/Question#17
4 day old boy, vomited throughout night after breastfeeding
21-Hydroxylase


Block 1/Question#18
68 yo man, chronically increased hydrostatic pressure in Bowman space
Benign prostatic hyperplasia


Block 1/Question#19
70 yo woman, increasingly severe pain in right knee over 3 months
Pleomorphic neoplastic cells producing new woven bone


Block 1/Question#23
22 yo man, professional cyclist
Eccentric hypertrophy


Block 1/Question#26
50 yo woman, chronic obstructive pulmonary disease
Endothelial nitric oxide synthase production


Block 1/Question#28
Cholera toxin is a catalyst that results in the inhibition of GTPase activity of G-stimulator protein
Concentration of cAMP


Block 1/Question#30
29 yo woman irregular menstrual periods
Provide follow-up appointments to assess the patient's progress in attaining her goals


Block 1/Question#31
7 yo boy appendectomy
Low blood solubility


Block 1/Question#32
52 yo man with chest pain and shortness of breath
Proximal tubule: isotonic; Macula densa: hypotonic; Medullary collecting duct: hypertonic


Block 1/Question#33
35 yo woman with pain and swelling of breasts, pelvic discomfort
Have a chaperone join them for the remainder of the examination


Block 1/Question#34
60 yo man, 1 day of fever, chills, confusion and memory loss
Vibrio vulnificus


Block 1/Question#38
45 yo homeless man found unconscious
Methylmalonic Acid: normal; Homocysteine: increased


Block 1/Question#43
18 yo man cracked lips and sunburned skin
Barrier


Block 1/Question#44
26 yo man skiing accident
Axillary


Block 1/Question#45
55 yo man; father and brother died of myocardial infarct at early age
Increased transcription of HMG-CoA reductase


Block 1/Question#46
65 yo man, generalized tonic-clonic seizures
High-grade fibrillary astrocytoma


Block 2/Question#8
39 yo man, polycystic kidney disease
pH: 7.22; PCO2: 28; HCO2: 11


Block 2/Question#9
19 yo woman being treated for meningococcal meningitis
Adrenocorticotropic hormone stimulation test


Block 2/Question#15
38 yo man, 1 week history of shortness of breath with exertion
Aortic regurgitation


Block 2/Question#17
65 yo woman, 1 week of swollen, painful knee
Uric acid


Block 2/Question#18
Researcher testing new cancer drug
Neutrophil counts


Block 2/Question#21
66 yo woman, 2 days of fever, flank pain, pain with urination, nausea
Calcium carbonate


Block 2/Question#25
40 yo man, 1 year of orthostatic hypotension and loose stools
Motility disorder


Block 2/Question#27
58 yo man, 4 years of recurrent cough and sputum
Pseudostratified columnar epithelial cells


Block 2/Question#29
32 yo woman, new neurologic finding; imaging shows cavernous sinus thrombosis
Inability to abduct the eye


Block 2/Question#30
35 yo man, 4 weeks of severe midline back pain
ACTH


Block 2/Question#32
Investigator studying vancomycin-resistant Enterococcus faecalis
Plasmid loss


Block 2/Question#34
25 yo woman, fatigue for 3 weeks
Greening reaction on blood agar


Block 2/Question#37
34 yo man, semiconscious and combative
Pseudocholinesterase


Block 2/Question#41
35 yo woman, 3 days fever and sharp chest pain
Virus


Block 2/Question#44
35 yo woman, passed out while washing dishes
K+: decreased; HCO3: increased; Anion gap: normal; pH: increased


Block 3/Question#3
17 yo boy septic shock
alpha-1-Adrenoreceptors


Block 3/Question#5
82 yo woman, 24 hours of constant severe lower abdominal pain
Fibrin


Block 3/Question#6
32 yo woman, diagnosis of hyperparathyroidism
Abnormal migration of endoderm from the fourth pharyngeal pouch


Block 3/Question#9
35 yo woman with infertility
Spillage of contrast, which is normal


Block 3/Question#12
58 yo woman, 6 months shortness of breath, nonproductive cough
Pulmonary hypertension


Block 3/Question#13
35 yo woman, 2 days pain in left leg
Drug-related antibodies


Block 3/Question#14
2 yo boy, 2 days of fever, sore throat, rash
Erythrogenic toxin


Block 3/Question#17
46 yo woman, 1 week of fever and joint pain
Inflammatory infiltrates in the interstitium


Block 3/Question#21
48 yo woman, gradual onset of back pain over 2 weeks
Metastatic carcinoma of the breast


Block 3/Question#22
70 yo woman routine pelvic examination
Cystocele


Block 3/Question#25
63 yo man, 2 weeks of fullness in left upper quadrant of abdomen
Myelofibrosis


Block 3/Question#26
33 yo man, diagnosed with epilepsy
He is medically qualified to drive


Block 3/Question#31
28 yo woman, 4 days of palpitations, severe neck pain, fatigue, malaise
Subacute granulomatous thyroiditis


Block 3/Question#32
25 yo woman, 2 years of intermittent, diffuse, cramping lower abdominal pain
Accentuation of mu-opioid myenteric plexus receptor


Block 3/Question#33
4 yo boy, clumsy gait for 1 year
1/4


Block 3/Question#34
52 yo woman with breast cancer
Contraction


Block 3/Question#40
47 yo woman with irregular, raised, multicolored dark lesion
Subcutaneous tissue


Block 3/Question#41
24 yo man, 3 days of progressive numbness of both feet
Myelinated primary afferents


Block 3/Question#45
65 yo patient with lung region underventilated but well perfused
Physiologic shunt


Block 3/Question#46
45 yo man for annual health maintenance examination
Fenofibrate


Block 3/Question#47
19 yo woman, 2 days of pain in left index finger
Flexor digitorum profundus tendon


Block 3/Question#48
52 yo man, chronic pancreatitis
Colipase


Block 4/Question#3
68 yo man, 3 days of increasingly severe deep chest pain
Aortic aneurysm


Block 4/Question#4
36 yo woman, 2 weeks of fatigue, bleeding gums, bone pain
Histone acetylase


Block 4/Question#14
18 yo woman ingests 100 aspirin tablets in suicide attempt
pH: 7.32; PCO2: 15; HCO3: 8


Block 4/Question#15
45 yo man follows up 1 week after appendectomy
Gilbert syndrome


Block 4/Question#27
54 yo man, normal renal function, receives heart transplant
Cyclosporine


Block 4/Question#29
65 yo man, cancer of the cecum
Ileocolic → superior mesenteric → portal → right hepatic branch of the portal


Block 4/Question#30
5 yo girl, 1 day severe leg pain after falling off sled
Intestinal calcium absorption


Block 4/Question#31
57 yo man with alcoholism
Liquefaction


Block 4/Question#35
73 yo man, 4 months poor appetite and 25 pound weight loss
Cytokine effect


Block 4/Question#36
18 yo woman given general anesthesia for wisdom tooth extraction
Sarcoplasmic Ca2+ release


Block 4/Question#37
66 yo man, 1 month nonproductive cough, 6 months progressive shortness of breath
Idiopathic pulmonary fibrosis


Block 4/Question#42
4 month old boy, abnormal glycogen storage
alpha-1,4-Glucosidase


Block 4/Question#45
35 yo man, prolonged QT interval
Outward (delayed) rectifying potassium channel


NBME 17

Block 1/Question#1
80 yo woman evaluated for suspected temporal arteritis
Additional testing to confirm the diagnosis of TA


Block 1/Question#6
55 yo man chronic bronchitis, found unresponsive in bed
Naloxone


Block 1/Question#8
6 week old girl, 6 days of vomiting a small amount of milk
Immature lower esophageal sphincter


Block 1/Question#14
21 yo man, excruciating anal pain for 4 hours
Inferior rectal vein


Block 1/Question#20
24 yo man, history of intravenous drug use, brought to ER 30 minutes after he could not be aroused
480


Block 1/Question#21
42 yo farmer, 7 mm red scaly plaque on ear
Actinic keratosis


Block 1/Question#28
12 yo boy, swimming in mountain stream; immersed in 60-degree water for 20 minutes
Central blood volume: increased; ADH (vasopressin): decreased; Atrial natriuretic peptide: increased


Block 1/Question#35
42 yo woman, 3 years of intermittent facial rash
Rosacea


Block 1/Question#38
Newborn with male genital ducts but female external genitalia
Scrotum


Block 1/Question#48
9 yo girl, poor growth over 1 year; below 3rd percentile for height; 10th percentile for weight
Diverticulum of the roof of the embryonic oral cavity


Block 2/Question#4
28 yo woman, 3 weeks of double vision
Area labeled with letter 'C'


Block 2/Question#5
56 yo man, sudden onset of uncontrollable irregular movements on left side of body for 4 hours
Right subthalamic


Block 2/Question#6
80 yo woman, 2 days of feeling funny
Hydrochlorothiazide


Block 2/Question#9
randomized clinical trial compares wound healing and cosmetic differences between two surgical procedures
Neither procedure is superior


Block 2/Question#11
13 yo girl, grade 2/6 holosystolic murmur over left fifth intercostal space
Tricuspid


Block 2/Question#12
2 month old boy given vaccine which converts T-independent antigens to T-dependent forms
Haemophilus influenzae type b


Block 2/Question#13
28 yo woman, 18 weeks gestation and palpitations
Free T4


Block 2/Question#19
21 yo man, brought to ER 45 minutes after sustaining multiple injuries in motor vehicle collision
Streptococcus pneumoniae


Block 2/Question#20
38 yo woman, 2 years of pain and heavy flow with menses
Proliferative endometrial tissue


Block 2/Question#22
60 yo man, 1 month of progressive shortness of breath
Pleural effusion


Block 2/Question#24
65 yo woman, ovarian cancer treated with cyclophosphamide
DNA replication


Block 2/Question#27
Polymorphic marker with three alleles, 1, 2 and 3, tightly linked to gene for polycystic kidney disease
2,3


Block 2/Question#33
Study conducted to assess effectiveness of lidocaine injections
Placebo effect


Block 2/Question#34
40 yo man, skin extremely sensitive to sunlight
Heme synthesis


Block 2/Question#35
40 yo woman, 1 year of episodic crampy abdominal pain, intermittent diarrhea, rectal bleeding with passage of mucus
Sulfasalazine


Block 2/Question#39
40 yo man, interstitial pulmonary fibrosis
Increased radial traction on airways


Block 2/Question#41
Seven hundred healthy women observed for 10 years
Cohort


Block 2/Question#45
25 yo woman, 3 years of irregular menses
21-Hydroxylase


Block 2/Question#46
38 yo man, brought to ER 30 minutes after being found near his home, unsbale to stand upright
Metabolic acidosis


Block 3/Question#2
3 yo boy and 5 yo brother, bruise easily, recurrent hemarthroses
Factor VIII (antihemophilic factor)


Block 3/Question#9
40 yo African American woman, 2 weeks of fever, malaise, dyspnea
1,25-Dihydroxycholecalciferol


Block 3/Question#11
30 yo woman, 20 weeks gestation, fundal height greater than expected
Tracheoesophageal atresia


Block 3/Question#13
15 yo girl, 1 day of redness, painful skin after sunbathing
First-degree burn


Block 3/Question#14
16 yo boy, no signs of puberty
Luteinizing hormone


Block 3/Question#16
14 yo boy, daily headaches for 2 months
Inhaled glue


Block 3/Question#19
65 yo woman, surgical repair of aneurysm of right internal carotid artery
Area labeled with letter 'A'


Block 3/Question#24
10 yo girl, well-child examination
Breast bud development


Block 3/Question#25
Physician is sad because he must inform patient of recent test results
Yes, it is.


Block 3/Question#26
34 yo man, lightheaded after 12 miles of marathon
Sympathetic efferent activity: increased; parasympathetic efferent activity: decreased


Block 3/Question#27
44 yo woman, follow-up examination, two Pap smears revealed atypical squamous cells
Ubiquitin ligase


Block 3/Question#29
75 yo man, 2 years of decreased force of urinary stream
Increased hydrostatic pressure in Bowman space


Block 3/Question#31
20 yo man, 6 hours of difficulty breathing and vomitting
Epinephrine


Block 3/Question#33
Female newborn delivered at 36 weeks, respiratory distress
Incomplete formation of pleuroperitoneal membrane


Block 3/Question#36
18 yo man, Crohn disease, admitted to hospital after 1 day of severe abdominal pain, intermittent bloody diarrhea
T-lymphocyte function


Block 3/Question#37
4 yo boy, two bacterial urinary tract infections over last year
Congenital ureteral obstruction


Block 3/Question#38
Ten healthy human subjects given new drug
Phase 1


Block 3/Question#41
27 yo woman, 12 hours of fever and abdominal pain
Struvite


Block 3/Question#49
48 yo nulligravid woman, 3 months excessive uterine bleeding
Endometrial hyperplasia


Block 4/Question#1
83 yo man found bedridden and confused
Early septic shock


Block 4/Question#3
46 yo man, recevied cardiac transplant, treated with oral cyclosporine
Suppressing the early response of T lymphocytes to activation


Block 4/Question#4
54 yo woman, hypertension and bilateral renal artery stenosis
Vasodilating prostaglandins at the afferent arteriole


Block 4/Question#10
32 yo woman, gravida 2, para 1, 7 weeks gestation
Ectopic pregnancy


Block 4/Question#14
55 yo man, admitted to hospital for treatment of sepsis
0.9% Saline


Block 4/Question#16
32 yo man, 3 months of swelling, ternderness of breasts
Tissue: Testicle; Effect: Estradiol production


Block 4/Question#20
45 yo man, 4 days of yellow skin
Mallory hyaline


Block 4/Question#23
72 yo man, weakness and fatigue
Gastrointestinal blood loss


Block 4/Question#27
20 yo man, suspected appendicitis, periumbilical burning and discomfort
T10


Block 4/Question#30
45 yo man, 1 month of intermittent bloody diarrhea and abdominal pain
Tumor necrosis factor


Block 4/Question#33
52 yo woman, hot flashes, 6 months of irregular menses
Failure of the ovaries to secrete 17β-estradiol


Block 4/Question#34
16 yo girl, 2 years of intermittent fainting while standing
Dopamine β-hydroxylase


Block 4/Question#36
41 yo woman, 6 weeks of increasingly severe headaches
Fibromuscular dysplasia


Block 4/Question#40
48 yo man, 3 months of increasing bronzing of skin, weakness, fatigue
Increased intestinal iron absorption


Block 4/Question#47
10 yo boy, anemia since birth; spleen is five times normal size
Hereditary spherocytosis


NBME 16

Block 1/Question#1
27 yo man, Hodgkin lymphoma, receives bone marrow transplant from cousin
Donor T lymphocytes reacting against host cells


Block 1/Question#2
18 month old boy, 3 hours lethargy, poor eating for past 24 hours
Long-chain acyl-CoA dehydrogenase


Block 1/Question#3
38 yo woman, 10 weeks epigastric pain, frequent stools
Serum calcium concentration


Block 1/Question#5
24 yo man, nasal congestion, watery nasal discharge, sneezing
α-Adrenergic agonist


Block 1/Question#7
2 yo boy, increased thirst, urinary frequency, failure to thrive
Amino acids: decreased; Glucose: decreased; Phosphate: decreased; HCO3: decreased


Block 1/Question#8
55 yo man, 2 weeks constipation after starting an over-the-counter medication
Dextromethorphan


Block 1/Question#14
Lesch-Nyhan syndrome
1/50,000


Block 1/Question#16
40 yo woman, gunshot wound to abdomen
Decreased function of Na+–K+ ATPase


Block 1/Question#17
Investigator studying pulmonary lymphatic flow using animal model
Intravenous infusion of 0.9% saline for 5 minutes


Block 1/Question#18
Screening program for detection of vaginal Chlamydia
10%


Block 1/Question#24
79 yo woman, right hip fracture after falling
Go for a long walk outside daily


Block 1/Question#26
16 yo boy, brought to ER after diving into 3-foot-deep swimming pool at night
Area labeled by the letter 'E'


Block 1/Question#30
5 yo boy, presents to ER after 16 hours of severe vomiting, increased sleepiness
Cerebral edema


Block 1/Question#37
54 yo man, aneurysm of distal abdominal aorta
2.4


Block 1/Question#39
28 yo woman, 1 month of pelvic pain, increasingly severe over the last week
Ureter


Block 1/Question#41
18 yo man, acute lymphoblastic leukemia, 3 days intermittent fever and left-sided chest pain
Amphotericin B


Block 1/Question#46
55 yo woman, 3 months shortness of breath
Parathyroid hormone: decreased; 1,25-Dihydroxycholecalciferol: increased


Block 1/Question#47
24 yo African, 3 months red bumps on face and chin
Pseudofolliculitis barbae


Block 1/Question#48
12 yo boy, 6 months difficulty walking and leg pain
Abnormal myelin sheaths


Block 1/Question#49
In an experiment, glycolytic intermediates are measured in human endothelial cells
Glyceraldehyde-3-phosphate dehydrogenase


Block 2/Question#3
48 yo woman, 6 months irregular menstrual periods, hot flashes
Increased follicle-stimulating hormone


Block 2/Question#13
5 yo boy, 8 months of recurrent middle ear and upper respiratory tract infection
Lysosomes


Block 2/Question#18
Animal study conducted to assess the effects of smoking on pulmonary defense
Mucus production and secretion: increased; Activity of airway cilia: decreased; Alveolar macrophage function: decreased


Block 2/Question#24
85 yo woman, fracture of the right femur, begins treatment with morphine
Morphine is metabolized to active metabolites that accumulate


Block 2/Question#37
33 yo man, 3 months muscle weakness and cramping
Glycogen phosphorylase


Block 2/Question#49
An experimental study of oxygen consumption in kidney
Proximal tubule


Block 2/Question#50
35 yo man, 3 years enlarging nose, coarsening facial features, muscle weakness, increased hand and foot size
Adenylyl cyclase


Block 3/Question#1
20 yo man, 4 hours abdominal pain, nausea, vomiting
Induction of cytochrome P450 enzymes that activate acetaminophen to a hepatotoxic metabolite


Block 3/Question#3
83 yo man, 3 days painful blisters on torso
Bullous pemphigoid antigen


Block 3/Question#5
45 yo man, congestive heart failure
Iron


Block 3/Question#7
15 yo girl, brought to ER 12 hours after ingesting 100 capsule vitamin D in suicide attempt
Increased absorption of calcium in the gastrointestinal tract


Block 3/Question#9
53 yo homeless man, alcoholism, found collapsed and coughing on park bench
Normal oral flora


Block 3/Question#12
18 yo woman, progressive fever, general malaise, blood in urine
Interstitial nephritis


Block 3/Question#17
Gram stain performed on sputum specimen
Outer membrane


Block 3/Question#20
Investigator studying strains of Streptococcus pneumoniae
Natural transformation


Block 3/Question#24
8 yo girl, well-child examination
“Your daughter’s development is normal.”


Block 3/Question#25
27 yo nulligravid woman, 2 years inability to conceive
Clomiphene


Block 3/Question#26
Study designed to evaluate ambient noise and hearing loss in automobile manufacturing plant
Cross-sectional


Block 3/Question#30
54 yo woman, nurse, routine tuberculosis screening
Interferon gamma


Block 3/Question#32
65 yo woman, 3 months of headache, weakness of arms, left flank pain
Pulmonary small cell carcinoma metastatic to the brain


Block 3/Question#38
68 yo man, 2 hours loss of vision
Right ophthalmic


Block 3/Question#39
27 yo woman, concerned of sleep apnea
Reassurance


Block 3/Question#40
Female newborn delivered at term to 35 yo primigravid woman
Enlarged thyroid gland


Block 3/Question#41
70 yo man, 8 months difficulty sleeping since wife died
Schedule regular appointments to monitor the patient


Block 3/Question#45
25 yo woman, 6 months of irregular mentrual periods, progressive acne
Fasting insulin: increased; Testosterone: increased; Luteinizing hormone: increased


Block 3/Question#50
10 yo girl, fatigue and appears pale
Deficiency of erythrocyte spectrin


Block 4/Question#8
24 yo woman, follow-up examination; 8 years of seizure disorder refractory to treatment
Tuberous sclerosis


Block 4/Question#11
78 yo man, 1 month fever, chills, fatigue, 5.4 kg weight loss
Bacterial endocarditis


Block 4/Question#12
39 yo woman, rheumatoid arthritis, follow-up examination
Tumor necrosis factor-α


Block 4/Question#24
35 yo man, 6 months burning abdominal pain one to two hours after eating
Gastrin


Block 4/Question#26
42 yo woman, biopsy of suspicious calcifications on mammogram
High-grade, low-stage neoplasm


Block 4/Question#27
18 yo man, brought to ER by mother 45 minutes after finding him crouched in closet
Brief psychotic disorder


Block 4/Question#32
70 yo woman, persistent fever despite intravenous broad-spectrum antibiotic therapy
Candida albicans


Block 4/Question#34
43 yo woman, 3 months progressive difficulty walking
Degeneration of motoneurons of the lumbar cord


Block 4/Question#35
51 yo woman, 6 months burning abdominal pain one to two hours after eating
Area labeled by the letter 'B'


Block 4/Question#39
32 yo man, begins to laugh while eating dinner with friends
While swallowing: closed; Immediately after laryngeal irritation: closed; while coughing: open


Block 4/Question#40
New antiplatelet agent developed for prevention of recurrence of stroke
8%


Block 4/Question#45
42 yo woman, brought to ER, 30 minutes after sudden onset of severe headache
Posterior communicating


Block 4/Question#48
32 yo woman, gravida 4, para 0, aborta 3, delivers female newborn at term with dysmorphic features, organ anomalies
Unbalanced chromosome rearrangement


Block 4/Question#49
40 yo woman, comes to ER, 1 week abdominal pain, watery and bloody diarrhea
Entamoeba histolytica


Block 4/Question#50
35 yo woman, participates in study of new diagnostic test of steroid hormones in saliva
Day 12


NBME 15

Block 1/Question#6
7 yo boy, 1 day fever, headache, nonproductive cough
Virion release


Block 1/Question#9
3 yo boy, cleft lip and palate, no other birth defects
Multifactorial


Block 1/Question#10
When compared to oxygenated blood, deoxygenated blood carries more carbon dioxide for a given PCO2
Deoxyhemoglobin is a better buffer of hydrogen ions than oxyhemoglobin


Block 1/Question#11
9 yo boy, mild mental retardation, 4 years increasingly frequent major motor seizures
Tuberous sclerosis


Block 1/Question#15
48 yo woman, comes to ER, palpitations
Increased cardiac parasympathetic activity


Block 1/Question#19
65 yo man, ischemic heart disease, fatigue, pain and swelling in legs
33%


Block 1/Question#24
3 yo girl, 2 weeks of diarrhea
Interferon-gamma receptor


Block 1/Question#32
4-day-old male newborn, brought to ER, respiratory distress and cyanosis
First


Block 1/Question#33
75 yo woman, 1 day fever and back pain
Releases NF-κB after undergoing phosphorylation


Block 1/Question#35
30 yo woman, uncomplicated vaginal delivery, delivers placenta but continued heavy blood loss
Oxytocin


Block 1/Question#37
36 yo man, heterozygous for LDL-receptor deficiency
LDL receptor


Block 1/Question#38
23 yo woman, 3 days drooping right eyelid
Oculomotor nerve


Block 1/Question#39
Investigator study, new behavioral program for attention-deficit/hyperactivity disorder (ADHD)
Stratification


Block 1/Question#44
59 yo man, 10 days shortness of breath, fatigue, cough
Imatinib


Block 1/Question#46
6 yo boy, severe mental retardation and choreoathetosis
0.2 to 0.5


Block 1/Question#48
22 yo man, brought to ER, 30 minutes after being hit by automobile
Deep fibular (peroneal)


Block 1/Question#49
23 yo woman, 3 weeks frequent thirst and urination
Glucokinase


Block 1/Question#50
25 yo man participates in study of muscle function
epp Amplitude: 1; mepp Amplitude: 1; Response to Ach: 1


Block 2/Question#3
2 yo girl, brought to ER, 20 minutes after ingesting insecticide
Atropine


Block 2/Question#4
32 yo man, annual company-sponsored health maintenance examination
Schizoid personality disorder


Block 2/Question#6
56 yo woman, 3 weeks progressive difficulty swallowing
Helicobacter pylori


Block 2/Question#9
67 yo man, 2 days double vision and drooping left eyelid
Aneurysm of the posterior communicating artery


Block 2/Question#11
48 yo man, brought to ER, 1 hour nausea, crushing chest pain
Degenerating epithelial cells and dirty brown granular casts


Block 2/Question#14
25 yo woman, rheumatic fever and mitral valve prolapse, 2 weeks of fever, fatigue
Streptococcus mitis


Block 2/Question#15
64 yo man, 2 months progressive shortness of breath
Increased fibrosis in the interstitium


Block 2/Question#20
30 yo man, 1 day irrational behavior, severe abdominal pain
Porphobilinogen deaminase


Block 2/Question#21
43 yo woman, 6 months altered consciousness
Complex partial


Block 2/Question#22
22 yo woman, HIV positive
Protein processing


Block 2/Question#23
26 yo woman, 2 weeks flank pain, palpitations, sweating, recurrent headaches
Area labeled by letter 'E'


Block 2/Question#26
47 yo man, admitted to hospital for myocardial infarction
Increased pulmonary capillary pressure


Block 2/Question#28
35 yo woman, gravida 1, para 1, 2 months generalized weakness and fatigability
Nicotinic acetylcholine receptor


Block 2/Question#29
2-month-old male infarct, brought to ER, 2 days generalized tonic-clonic seizures
Glycine receptor


Block 2/Question#31
24 yo woman, Marfan syndrome, positive home pregnancy test
Hypervolemia


Block 2/Question#32
25 yo primigravid woman, 25 weeks gestation, routine prenatal examination
Prematurity


Block 2/Question#36
72 yo woman, admitted to hospital for acute myocardial infarction
Left coronary, circumflex, posterior interventricular (posterior descending)


Block 2/Question#39
43 yo man, 10 years alcoholism, change in skin color
Decreased glutathione


Block 2/Question#40
4 yo boy, 2 months progressive weakness, loss of muscle function
Cytoskeleton


Block 2/Question#41
45 yo man, has not been examined by a physician for 30 years
Mitral regurgitation


Block 2/Question#43
37 yo woman, brought to ER by husband after being found unconscious
Cardiogenic


Block 2/Question#45
3 yo girl, 1 year of short stature
Abnormal targeting of these enzymes to lysosomes


Block 2/Question#47
75 yo man, chronic obstructive pulmonary disease, admitted to hospital 6 hours after acute exacerbation
C5a


Block 2/Question#49
1950s study to determine the causes of lung cancer
Cohort study


Block 3/Question#3
56 yo woman, brought to ER, 2 hours fever and shortness of breath
Lipopolysaccharide


Block 3/Question#6
50 yo man, routine health maintenance examination
Medullary


Block 3/Question#7
1 yo boy, 4 weeks progressive generalized tonic-clonic seizures
RNA splice error


Block 3/Question#9
Newborn undergoes surgical repair of esophageal atresia
Endoderm


Block 3/Question#10
5 yo boy stung on foot by bee
Gap formation between endothelial cells


Block 3/Question#15
65 yo man, hypertension, participates in clinical trial of loop diuretic
Acid-base: Metabolic alkalosis; Volume contraction: yes


Block 3/Question#18
27 yo man, 3 hours nausea, cramping abdominal pain, diarrhea
Prolonged fecal excretion of the organism


Block 3/Question#24
28 yo African American man, 3 months mild fatigue, weakness, 4.5 kg weight loss
Ethnicity


Block 3/Question#30
13 yo boy, receiving chemotherapy for leukemia
T-lymphocyte thymocytes localized to the thymic cortex


Block 3/Question#32
2-month-old girl, follow-up examination 2 days after abnormal complete blood count
Congenital neutropenia


Block 3/Question#39
42 yo woman, multiple sclerosis, double vision since yesterday morning
Medial longitudinal fasciculus


Block 3/Question#43
18 yo man, sports physical examination
Inquiry about a history of anabolic steroid use


Block 3/Question#45
30 yo woman, Hodgkin disease 10 years ago, treated with radiation and chemotherapy for 6 months
Therapy for Hodgkin disease causes mutations in hematopoietic stem cells, and one mutant cell progresses to leukemia


Block 3/Question#47
2-month-old boy, hypotonia and poor feeding since birth
Peroxisomes


Block 3/Question#48
A study finds a statistically significant difference between two groups when, in reality, there isn't one. What is the name of this statistical error?
5%, Type I error


Block 4/Question#3
51 yo man, Wegener granulomatosis, follow-up examination
Hematuria


Block 4/Question#5
Male newborn delivered at term with right-sided aortic arch
Third and fourth branchial pouches


Block 4/Question#7
17 yo boy, chronic renal insufficiency, undergoes unilateral nephrectomy
Hydronephrosis


Block 4/Question#8
Newborn delivered at 28 weeks, severe respiratory distress
Lung elastic recoil


Block 4/Question#9
40 yo woman, breast cancer, 1 week progressive loss of left-sided peripheral vision in both eyes
Occipital lobe


Block 4/Question#11
45 yo man, follow-up examination, 2 weeks after starting hydrochlorothiazide
Venous return: decreased; Carotid sinus baroreceptor activity: decreased; Cerebral blood flow: decreased


Block 4/Question#17
18 yo woman, 3 days pain with urination, urinary frequency, urinary urgency
β-Lactamase production


Block 4/Question#20
52 yo man, 3 days after sudden onset of left eye blindness
No constriction because the retinal ganglion cells in the left eye have been destroyed


Block 4/Question#25
Couple has two children with osteogenesis imperfecta
Germline mosaicism


Block 4/Question#26
65 yo woman, follow-up examination, DEXA scan shows decreased bone density
Osteoblast activity: decreased; Osteoclast activity: increased; RANKL: increased


Block 4/Question#29
45 yo woman, routine health maintenance examination
Incomplete penetrance


Block 4/Question#30
25 yo woman, 5 months palpitations, insomnia, 5 kg weight loss
Nuclear/retinoid X binding to DNA


Block 4/Question#32
70 yo woman, found dead in skilled nursing care facility
Hypertrophy


Block 4/Question#33
During normal skeletal muscle twitching, ATP concentration does not fall significantly.
ATP is quickly regenerated from creatine phosphate


Block 4/Question#38
25 yo woman, 1 week general malaise, facial rash
Thrombocytopenia


Block 4/Question#40
18-month-old boy, severe combined immunodeficiency syndrome
Irradiated packed red blood cells


Block 4/Question#42
4 yo boy, karyotype 47,XY+21
Excess lymphoblasts


Block 4/Question#44
72 yo woman, 6 months diffuse muscle pain, weakness
Osteomalacia


Block 4/Question#47
31 yo woman, treated for Plasmodium vivax malaria
Primaquine kills hypnozoites


Block 4/Question#48
Study of effectiveness of cough medication in children
Lack of blinding between groups


NBME 13

Block 1/Question#1
77 yo woman, dies in hospital after long illness
Interleukin-1 (IL-1)


Block 1/Question#13
18-month-old boy, 6 months progressive facial abnormalities, slow growth
Iduronate sulfatase


Block 1/Question#19
22 yo woman, 3 months painless, slowly enlarging mass on left neck
Anterior to the sternocleidomastoid muscle


Block 1/Question#20
3 yo girl, grade 4/6, loud, harsh, high-pitched holosystolic murmur
Ventricular septal defect


Block 1/Question#25
32 yo woman, 1 month progressive shortness of breath and anxiety
Myasthenia gravis


Block 1/Question#26
4 yo boy, brought to ER, 1 hour headache, nausea, vomiting, dizziness
Reaction step labeled by the letter 'E'


Block 1/Question#27
12 yo African, brought to ER, 6 hours fever, severe rib pain
Polymerization of hemoglobin with hypoxic conditions due to amino acid substitution in the β chain


Block 1/Question#29
43 yo woman, metastatic colon cancer, taking bevacizumab
The agent being a humanized antibody


Block 1/Question#30
43 yo man, routine health maintenance examination
Low-calorie


Block 1/Question#41
20 yo man, cramping periumbilical pain; pain shifts to right lower quadrant
Interleukin-1 (IL-1)


Block 1/Question#43
18 yo man, 8 days temperature of 38.3 C, sore throat, cervical lymph node enlargement
T lymphocytes


Block 1/Question#48
Male newborn at 34 weeks gestation delivered vaginally
Endothelium


Block 2/Question#1
15 yo boy, 2 months sneezing, coughing, watery eyes after mowing lawn
Type I (immediate) hypersensitivity


Block 2/Question#6
Female newborn, delivered at 34 weeks gestation, advanced-care setting
Nitric oxide


Block 2/Question#8
5-month-old boy, 5 days difficulty feeding
Thyroglossal duct


Block 2/Question#9
Study of coronary artery disease (CAD) risk factors, persons aged 30 and older
Observational cohort study


Block 2/Question#21
36 yo man, HIV seropositive, 2 weeks nonproductive cough
Pneumocystis jiroveci (formerly P. carinii)


Block 2/Question#30
47 yo woman, physical examination shows fine wrinkles in photodamaged skin on face
Activation of nuclear gene transcription


Block 2/Question#38
5 yo boy, 6 months progressive clumsiness and fatigue
Ischium


Block 2/Question#41
23 yo woman, 3 weeks persistent cough worsened by cold air
Dextromethorphan


Block 2/Question#45
54 yo man, squamous cell carcinoma of right lung
Loss of heterozygosity


Block 3/Question#5
42 yo Asian woman, brought to ER, 24 hours nausea, vomiting, progressive lethargy
Induction of cytochrome P450


Block 3/Question#6
Homologous pairing of chromosomes in prophase I
Crossing over


Block 3/Question#7
32 yo woman, 5 years inability to conceive
Clomiphene


Block 3/Question#11
31 yo woman, brought to ER, 10 minutes difficulty breathing, severe muscle weakness
Desensitization of nicotinic receptors


Block 3/Question#14
40 yo man, brought to ER, 1 hour after sudden onset of severe pain in left leg
Increased protein degradation


Block 3/Question#15
33 yo woman, right-handed, 3 days progressive weakness, numbness of arms and legs
Voltage-gated Na+ channels


Block 3/Question#19
Study of onset and course of cardiovascular disease in African American men and women
Population-based


Block 3/Question#21
Autopsy of 46 yo woman, adenocarcinoma of colon
Paraganglioma


Block 3/Question#30
Cluster of three cases of nosocomial pneumonia caused by Klebsiella pneumonia
Promote thorough hand cleansing before and after medical personnel visit each patient


Block 3/Question#31
23 yo woman, type 1 diabetes mellitus, follow-up examination
Inability to produce hydroxy-halide radicals


Block 3/Question#35
25 yo woman, radical mastectomy with removal of left axillary lymph nodes
Compression sleeve


Block 3/Question#39
Young adult couple, 2 years unable to conceive
Seminal vesicles


Block 3/Question#45
25 yo man, cystic fibrosis, 3 days fever, cough, progressive shortness of breath
Biofilm formation in the lower respiratory tract


Block 4/Question#2
18 yo woman, mild mental retardation, 3 days decreased ability to see in reduced light
Apo B


Block 4/Question#7
Mouse melanoma, B-16, highly metastatic
Homing


Block 4/Question#13
22 yo woman, follow-up examination, pulmonary embolism 1 year ago
Antiphospholipid antibody syndrome


Block 4/Question#20
32 yo man, brought to ER, 1 day intermittent flashing spots, blurred vision, vomiting, confusion, difficulty walking
Alcohol dehydrogenase


Block 4/Question#21
40 yo woman, brought to ER, 30 minutes after severe chest injuries in motor vehicle collision
Vascular malformation


Block 4/Question#34
33 yo woman, 16 kg weight gain over 6 months despite dieting
Cortical hyperplasia


Block 4/Question#35
55 yo man, hepatic encephalopathy, 24 hours of confusion and lethargy
Lactulose


Block 4/Question#36
25 yo man, admitted to hospital for viral pneumonia
Alveolar hyaline membrane


Block 4/Question#42
64 yo woman, 6 months heartburn, difficulty swallowing solid food and liquid
Esophageal peristalsis: decreased; Lower esophageal sphincter tone: decreased


Block 4/Question#46
62 yo man, brought to ER, 3 hours progressive difficulty breathing, mild left shoulder pain
Pulmonary edema