NBME 20

Block 1/Question#1
A 37-year-old nurse is accidentally stuck with a needle used ...
Inhibits reverse transcriptase

Block 1/Question#2
A mother who has toxoplasmosis gives birth to an asymptomatic ...
Antitoxoplasma IgM antibody concentrations

Block 1/Question#3
A 48-year-old man comes to the physician for a routine ...
Upregulation of the LDL receptors

Block 1/Question#4
A 50-year-old man is brought to the emergency department by ...
Formic acid

Block 1/Question#5
A 24-year-old African American man comes to the physician ...
Pseudofolliculitis barbae

Block 1/Question#6
A 16-year-old student has uncontrollable sleepiness, falling ...
Direct transition from wakefulness to REM sleep

Block 1/Question#7
A 5-year-old girl with AIDS develops a progressive ...
Thymidine kinase

Block 1/Question#8
A 10-year-old girl is brought to the physician by her mother ...
Breast bud development

Block 1/Question#9
A 50-year-old man is brought to the physician by his wife ...
Pick disease

Block 1/Question#10
A 77-year-old woman has been having difficulty fastening ...
C7-T1 foraminal stenosis

Block 1/Question#11
The sequence surrounding the first two exons of the human ...
Disruption of normal splicing by creation of a new 3′ splice site

Block 1/Question#12
A 72-year-old woman with dysphagia is undergoing surgical ...
Right kidney

Block 1/Question#13
A 6-week-old girl is brought to the physician by her mother ...
Immature lower esophageal sphincter

Block 1/Question#14
A 28-year-old man who is a migrant worker comes to the clinic ...
Psoas major

Block 1/Question#15
A 30-year-old man who completed a successful course of ...
Adjustment disorder with anxiety

Block 1/Question#16
A 30-year-old woman with multiple sclerosis comes to the ...
Pons

Block 1/Question#17
A 50-year-old woman comes to the physician because of a ...
Drug effect

Block 1/Question#18
A 36-year-old man comes to the physician because he has not ...
Urine output: increased; Urine potassium: increased

Block 1/Question#19
A 60-year-old man comes to the physician because of a 6-week ...
Urine Na+: increased; Serum osmolality: decreased

Block 1/Question#20
An 8-year-old boy is evaluated for ventricular systolic ...
Coarctation of the aorta

Block 1/Question#21
A 75-year-old woman comes to the physician because of a ...
Multinucleated giant cells and neutrophil infiltrates

Block 1/Question#22
A 38-year-old woman comes to the physician because of a 3-day ...
Vagus

Block 1/Question#23
A 34-year-old man who is HIV positive is brought to the ...
CD4+ T lymphocytes

Block 1/Question#24
A 50-year-old man comes to the physician because of a ...
Omeprazole

Block 1/Question#25
A 25-year-old primigravid woman at 42 weeks’ gestation is ...
Phosphoinositide hydrolysis

Block 1/Question#26
Serum cholesterol concentrations are measured as part of a ...
16%

Block 1/Question#27
A 53-year-old woman comes to the physician because of a ...
Schistosoma mansoni

Block 1/Question#28
A previously healthy 16-year-old girl comes to the physician ...
Trichomonas vaginalis

Block 1/Question#29
During an experiment, an investigator isolates an abnormal ...
Lysine

Block 1/Question#30
A 33-year-old woman comes to the emergency department 1 hour ...
Lunate

Block 1/Question#31
A 66-year-old man has had fatigue, shortness of breath, and ...
Focal pulmonary fibrosis

Block 1/Question#32
A 56-year-old woman is brought to the emergency department ...
Placement of the central line via the left internal jugular vein

Block 1/Question#33
A 17-year-old girl comes to the emergency department because ...
Mitochondrial

Block 1/Question#34
A strain of Escherichia coli produces a temperature-sensitive ...
Missense

Block 1/Question#35
A 70-year-old man dies of coronary artery disease. He had a ...
Spastic hemiparesis on the right

Block 1/Question#36
A 56-year-old man is admitted to the hospital after an ...
Rhabdomyolysis

Block 1/Question#37
A 1-month-old male newborn is brought to the emergency ...
Na+: 132; K+: 3.2; Cl: 90; HCO3: 37

Block 1/Question#38
A 9-year-old girl is brought to the physician because of poor ...
Diverticulum of the roof of the embryonic oral cavity

Block 1/Question#39
A 3-month-old boy is brought to the office by his mother ...
Lateral to the inferior epigastric artery and superior to the inguinal ligament

Block 1/Question#40
Monoclonality of neoplastic cells in endometrial carcinoma ...
X chromosome-linked isoenzymes

Block 1/Question#41
A 45-year-old man has fever, chills, dysuria, and a tender, ...
Escherichia coli

Block 1/Question#42
A 60-year-old man has two-pillow orthopnea, severe dyspnea, ...
Jugular venous pressure of 12 mm Hg

Block 1/Question#43
A randomized clinical trial is conducted to compare wound ...
Neither procedure is superior

Block 1/Question#44
A 35-year-old woman with newly diagnosed hypertension comes ...
MR angiography of the renal arteries

Block 1/Question#45
A 2-year-old boy is brought to the physician because of ...
Amino Acids: decreased; Glucose: decreased; Phosphate: decreased; HCO3–: decreased

Block 1/Question#46
A 55-year-old woman comes to the physician for a follow-up ...
Cholecalciferol

Block 1/Question#47
A 60-year-old woman with type 2 diabetes mellitus is brought ...
Rupture of a papillary muscle

Block 1/Question#48
An otherwise healthy 4-month-old girl is brought to the ...
Spontaneous involution

Block 1/Question#49
A 56-year-old man comes to the physician because of a 6-month ...
Fibromuscular hyperplasia of arterioles

Block 1/Question#50
A 26-year-old man undergoes an abdominal exploratory ...
Splenic

Block 2/Question#1
A 17-year-old girl comes to the emergency department because ...
Speak with the patient and her parents about the findings

Block 2/Question#2
Following a wedding reception that was attended by 75 people, ...
Norovirus

Block 2/Question#3
An investigator compares the DNA sequences of a group of ...
5′ CCGG

Block 2/Question#4
A 56-year-old woman has frequently burned herself while ...
Syrinx of the central region of the spinal cord from C-4 to T-5

Block 2/Question#5
A 32-year-old woman has had fecal incontinence since giving ...
Damage to the anal sphincter

Block 2/Question#6
An 18-year-old boy has just been diagnosed with ...
50%

Block 2/Question#7
A 30-year-old man comes to the physician because of a 3-month ...
Increased osteoclast maturation and activity

Block 2/Question#8
Three elderly residents of an assisted living facility in ...
Legionella pneumophila

Block 2/Question#9
An otherwise healthy 16-year-old girl comes to the physician ...
Cold, dry air

Block 2/Question#10
A 70-year-old woman is transferred to a rehabilitative ...
Activity level before the fracture

Block 2/Question#11
A female newborn delivered at 36 weeks' gestation is in ...
Incomplete formation of pleuroperitoneal membrane

Block 2/Question#12
An 80-year-old man with type 2 diabetes mellitus is brought ...
Pelvic splanchnic

Block 2/Question#13
A 25-year-old woman comes to the physician because of a 2-day ...
A phospholipid (cardiolipin) on charcoal particles

Block 2/Question#14
A 23-year-old woman has had fever, hypotension, and ...
Streptococcus pneumoniae

Block 2/Question#15
A 55-year-old man comes to the physician because of ...
Dextromethorphan

Block 2/Question#16
A 10-year-old boy with mild mental retardation is brought to ...
Tuberous sclerosis

Block 2/Question#17
A 57-year old man has a hemoglobin concentration of 18.5 ...
Chronic obstructive pulmonary disease

Block 2/Question#18
A 65-year-old man is brought to the emergency department ...
ST-segment elevation

Block 2/Question#19
A 66-year-old man is brought to the emergency department 30 ...
Cigarette smoking

Block 2/Question#20
A 19-year-old man who is a college student is brought to the ...
Subcutaneous crepitus

Block 2/Question#21
A 25-year-old woman comes to the physician 2 days after ...
Granulomas containing stellate microabscesses

Block 2/Question#22
A 44-year-old woman comes to the physician for a follow-up ...
Ubiquitin ligase

Block 2/Question#23
Which of the following changes in the cardiovascular system ...
Increased basal systolic blood pressure

Block 2/Question#24
A patient with a 1-week history of diarrhea has reduced ...
Decreased arterial Pco2

Block 2/Question#25
A 14-year-old girl is brought to the physician because of a ...
Mitochondrial tRNALeu

Block 2/Question#26
A male newborn is found to have a decreased blood thyroxine ...
Thyroid hormone-binding globulin deficiency

Block 2/Question#27
A 38-year-old African American man with recently diagnosed ...
It should play a role because the efficacy of certain classes of medications varies among different ethnicities

Block 2/Question#28
At a postnatal checkup, a 6-week-old female newborn weighs 20 ...
Annular pancreas

Block 2/Question#29
A 25-year-old woman has a flu-like illness (fever, myalgias, ...
Picornavirus

Block 2/Question#30
A 78-year-old man is brought to the emergency department by ...
Cortisol

Block 2/Question#31
A 25-year-old man comes to the physician 8 hours after the ...
Rupture of an intervertebral disc

Block 2/Question#32
A 12-year-old girl is brought to the physician by her mother ...
Osteoblasts

Block 2/Question#33
A study is conducted to assess the effect of a new screening ...
Lead-time

Block 2/Question#34
A 28-year-old man has excessive thirst and polyuria. The ...
Hypothalamus

Block 2/Question#35
A 36-year-old woman comes to the office because of a 1-month ...
Splenomegaly

Block 2/Question#36
A 31-year-old man has a large, yellow, soft mass deeply ...
Liposarcoma

Block 2/Question#37
A 28-year-old woman of Eastern European Jewish decent comes ...
Recombinational double-stranded DNA break repair

Block 2/Question#38
A 50-year-old woman with a restrictive pulmonary disorder ...
Functional residual capacity: decreased; Residual volume: decreased; Vital capacity: decreased

Block 2/Question#39
A 29-year-old man comes to the physician because of a 1-week ...
Absence of peptidoglycan

Block 2/Question#40
A 70-year-old man has a 3-month history of weakness and a ...
Squamous cell carcinoma

Block 2/Question#41
Purified serum antibodies elicited by immunization with ...
Proteins X and Y express the same epitopes

Block 2/Question#42
A previously healthy 32-year-old woman is brought to the ...
Preload

Block 2/Question#43
An 18-year-old woman comes to the physician because she has ...
Ovaries

Block 2/Question#44
A 43-year-old woman, gravida 2, para 1, at 10 weeks' ...
Nuchal translucency (fetal ultrasound): increased;
Pregnancy-associated Plasma Protein (maternal serum): decreased;
Human Chorionic Gonadotropin (maternal serum): increased


Block 2/Question#45
A new antiplatelet agent is developed for the prevention of ...
8%

Block 2/Question#46
A physician prescribes a newly marketed drug to 45 patients. ...
Discontinue the new drug in affected patients and file MedWatch reports on the FDA's Web site

Block 2/Question#47
A 35-year-old man comes to the physician to discuss donating ...
1:4

Block 2/Question#48
A sedentary 50-year-old man with hypertension comes to the ...
Antidepressant therapy

Block 2/Question#49
An 82-year-old woman is brought to the physician because of a ...
Decreased slope of diastolic depolarization

Block 2/Question#50
A 27-year-old woman comes to the physician because of a ...
Pheochromocytoma

Block 3/Question#1
The frequency of an autosomal recessive disease in a ...
1/25

Block 3/Question#2
A 23-year-old woman is brought to the emergency department ...
Xanthine oxidase

Block 3/Question#3
A 45-year-old woman has a thyroidectomy because of asymmetric ...
Calcitonin

Block 3/Question#4
An 18-year-old woman comes to the physician because of fever, ...
Reactive T lymphocytes

Block 3/Question#5
A 35-year-old man comes to the physician because of a 2-month ...
Methotrexate

Block 3/Question#6
A new drug has the following effects on the activity of the ...
Pathway labeled 'H' (Conversion of Leukotriene A4 to Leukotriene B4

Block 3/Question#7
A 10-year-old boy has a palpable mass in the ventral midline ...
Endoderm of foramen caecum

Block 3/Question#8
A 12-year-old girl is brought to the physician for a ...
Polyubiquitination

Block 3/Question#9
A 62-year-old man comes to the physician because of pain in ...
Prostate

Block 3/Question#10
A 59-year-old man develops fatigue and decreased appetite 3 ...
Hemolysis

Block 3/Question#11
A 3-year-old boy is brought to the physician because of a ...
Heterozygous mutation in the ankyrin gene

Block 3/Question#12
A 46-year-old man has dyspnea, orthopnea, and a midsystolic ...
Mitral regurgitation

Block 3/Question#13
A 45-year-old woman develops proteinuria and hematuria. She ...
Tubulointerstitial nephritis

Block 3/Question#14
During a clinical study, an investigator tests a new drug for ...
Increase the sample size

Block 3/Question#15
A 23-year-old woman, who was diagnosed with Sjögren syndrome ...
Substance P

Block 3/Question#16
A 41-year-old woman with systemic lupus erythematosus is ...
Ask the attending physician to obtain informed consent

Block 3/Question#17
A 45-year-old man comes to the emergency department because ...
Schizoid personality disorder

Block 3/Question#18
An 18-year-old woman comes to the physician to request ...
50%

Block 3/Question#19
A 23-year-old man comes to the physician because of a 1-month ...
Area labeled ‘B’ (Mitochondrion)

Block 3/Question#20
A 67-year-old woman comes to the physician for a health ...
Low sensitivity

Block 3/Question#21
A newborn is born with a lethal chromosome defect. He is ...
Feed by whatever means necessary to maintain comfort

Block 3/Question#22
In patients with breast cancer, metabolically stable agonists ...
Gonadotropin by the pituitary gland

Block 3/Question#23
A 50-year-old woman is brought to the emergency department by ...
pKa: 6.0; Protein binding in plasma: 20%; Volume of distribution at steady state: 1 L/kg

Block 3/Question#24
A 2-month-old girl is brought to the emergency department by ...
Thyroid function tests

Block 3/Question#25
A 4-week-old infant is brought to the emergency department ...
Hypertrophic pyloric stenosis

Block 3/Question#26
A 3-month-old boy is brought to the physician because of ...
Mannose 6-phosphate

Block 3/Question#27
A 55-year-old man with type 2 diabetes mellitus, ...
Pravastatin

Block 3/Question#28
A 23-year-old woman who is 6 months pregnant develops deep ...
Antiplatelet antibodies

Block 3/Question#29
An 83-year-old man is brought to the emergency department ...
Early septic shock

Block 3/Question#30
A 22-year-old woman who recently emigrated from rural Mexico ...
Obstruction of the right interventricular foramen (foramen of Monro)

Block 3/Question#31
A 62-year-old woman comes to the physician because of ...
β-Tubulin

Block 3/Question#32
A 54-year-old woman with terminal metastatic pancreatic ...
Nonmaleficence

Block 3/Question#33
A 31-year-old woman receives a prescription for tetracycline ...
Formation of complexes with mineral ions

Block 3/Question#34
A 22-year-old woman comes to the emergency department because ...
Release of bacterial products

Block 3/Question#35
A 51-year-old man has the acute onset of fever and ...
Cytomegalovirus infection

Block 3/Question#36
A 4-year-old boy has had fever, abdominal cramping, and ...
Shigella sonnei

Block 3/Question#37
A 62-year-old man with alcohol-induced liver disease develops ...
Spironolactone

Block 3/Question#38
A 23-year-old man with a 3-year history of schizophrenia is ...
Psychogenic polydipsia

Block 3/Question#39
A 19-year-old woman has severe refractory pustular acne that ...
Teratogenic effects in the embryo

Block 3/Question#40
Two days after admission to the hospital because of ...
Do not proceed with the transfusion

Block 3/Question#41
A 2-year-old child undergoes resection of the right kidney ...
Increase in glomerular size

Block 3/Question#42
A 13-year-old girl has an episode of severe cellular ...
Epstein-Barr virus genome

Block 3/Question#43
A 71-year-old man comes to the physician because of a 6-month ...
Cilostazol

Block 3/Question#44
A 56-year-old man is brought to the emergency department 30 ...
Capillary hydrostatic: increased; Interstitial hydrostatic: increased; Interstitial oncotic: decreased

Block 3/Question#45
A 39-year-old man reports bright red spots on the toilet ...
Constipation

Block 3/Question#46
Removal of the thymus at birth results in severely impaired ...
Thymic lymphocytes produced before thymectomy are long-lived

Block 3/Question#47
A 60-year-old woman has prolonged apnea following general ...
Succinylcholine

Block 3/Question#48
A 48-year-old woman comes to the physician because of a ...
Hypothyroidism

Block 3/Question#49
A 92-year-old woman who was recently admitted to a nursing ...
Atrophy of dermal collagen

Block 3/Question#50
A 62-year-old man comes to the physician because of a 1-week ...
Agonist at γ-aminobutyric acid B (GABAB) receptors

Block 4/Question#1
A 32-year-old man comes to the physician because of a 3-month ...
Tissue: testicle; Effect: estradiol production

Block 4/Question#2
A study is conducted to identify healthy women at risk for ...
Liver

Block 4/Question#3
A 23-year-old woman comes to the physician for a follow-up ...
Collagen synthesis

Block 4/Question#4
A 20-year-old man comes to the physician stating that food ...
Olfactory

Block 4/Question#5
Immediately after a cerebral infarction, a 62-year-old ...
Area labeled ‘A’ (Broca’s area)

Block 4/Question#6
A 51-year-old man develops diaphoresis, tachycardia, and a ...
Alcohol withdrawal

Block 4/Question#7
A 33-year-old woman with HIV infection is brought to the ...
Non-Hodgkin lymphoma

Block 4/Question#8
A 58-year-old man is brought to the emergency department ...
Hypertension

Block 4/Question#9
A previously healthy 37-year-old woman comes to the physician ...
Tumor of the adrenal zona fasciculata

Block 4/Question#10
A 65-year-old woman who has a 25-year history of chronic ...
Hydroxylation of proline

Block 4/Question#11
A 37-year-old man who is HIV positive comes to the physician ...
Nortriptyline

Block 4/Question#12
An investigator is conducting a randomized, double-blind, ...
Analyze all nonadherent participants according to the group of the study to which each was randomized

Block 4/Question#13
A 62-year-old woman comes to the physician because of a ...
Bronchogenic carcinoma

Block 4/Question#14
A 60-year-old man has a round, semitransparent nodule on his ...
Basal cell carcinoma

Block 4/Question#15
A 45-year-old man is undergoing a surgical procedure. Which ...
Decreasing respiratory rate

Block 4/Question#16
An investigator wishes to determine the effectiveness of a ...
Ductal ion reabsorption is more efficient at low flow rates

Block 4/Question#17
A previously healthy 55-year-old man has recently been ...
Renal artery stenosis

Block 4/Question#18
A 35-year-old man comes to the physician because of a 6-month ...
Gastrin

Block 4/Question#19
A 55-year-old man with severe emphysema comes to the ...
Percussion: hyperresonant; Tactile fremitus: decreased; Expiratory phase: prolonged

Block 4/Question#20
A 5-year-old boy is brought to the physician for a follow-up ...
Hypophosphatemia

Block 4/Question#21
A 47-year-old woman comes to the physician because of a ...
Contact with parakeets

Block 4/Question#22
A 35-year-old man is given cyclosporine following a liver ...
Decreased synthesis of interleukins

Block 4/Question#23
A 45-year-old woman who is intubated and mechanically ...
β-Glucan carbohydrates in the cell wall

Block 4/Question#24
A 27-year-old man comes to the physician because of weakness ...
Deep branch of the ulnar nerve at the hook of the hamate bone

Block 4/Question#25
A 52-year-old man is brought to the emergency department ...
Increased total peripheral resistance and decreased cardiac output

Block 4/Question#26
A 33-year-old man comes to the physician because of a 3-week ...
Rectus femoris

Block 4/Question#27
An investigator is studying patients with West Nile virus ...
Case series

Block 4/Question#28
A 78-year-old man dies of chronic congestive heart failure. ...
Failure of the Na+–K+ pump

Block 4/Question#29
A 15-year-old girl is brought to the physician by her mother ...
Doxycycline

Block 4/Question#30
A 32-year-old woman is brought to the emergency department 20 ...
Arterial laceration

Block 4/Question#31
A 48-year-old man is brought to the emergency department 12 ...
Cl-: 96 mEq/L; HCO3-: 8 mEq/L

Block 4/Question#32
A 55-year-old man comes to the physician because of a 2-month ...
Partial oxidation of fatty acids

Block 4/Question#33
A 65-year-old woman with cardiovascular disease is found to ...
Increased bile salt

Block 4/Question#34
A 20-year-old man is brought to the physician by his mother ...
How frightening for you to see your son like this. Do you have any idea about what might be causing his behavior?""

Block 4/Question#35
A 62-year-old man comes to the physician for a follow-up ...
Contemplation

Block 4/Question#36
A 25-year-old woman is brought to the emergency department ...
Factitious disorder

Block 4/Question#37
A 16-year-old girl with cystic fibrosis is brought to the ...
Vitamin E

Block 4/Question#38
A 45-year-old man comes to the physician because of ...
Tumor necrosis factor

Block 4/Question#39
A 30-year-old woman develops serum sickness following ...
C3a

Block 4/Question#40
A 6-month-old girl is brought to the emergency department by ...
Ornithine transcarbamylase

Block 4/Question#41
A 56-year-old man with a 20-year history of chronic back pain ...
Naloxone

Block 4/Question#42
A 65-year-old woman dies 6 months after the onset of severe ...
Meningeal

Block 4/Question#43
A physician is assigned to a search and rescue team ...
Negative nitrogen balance

Block 4/Question#44
A 45-year-old man comes to the office for counseling prior to ...
Starchy foods

Block 4/Question#45
A 12-year-old boy is brought to the physician for further ...
Terminal components of complement

Block 4/Question#46
A 28-year-old woman at 32 weeks' gestation comes to the ...
Obstructive uropathy

Block 4/Question#47
A 61-year-old man has erectile dysfunction due to spinal cord ...
Area labeled ‘D’ (Corpus cavernosum)

Block 4/Question#48
A 24-year-old man comes to the emergency department because ...
Lipoprotein lipase

Block 4/Question#49
A 23-year-old woman sustains significant blood loss in a ...
Direct antiglobulin test

Block 4/Question#50
A previously healthy 16-year-old girl is brought to the ...
Prescribe antibiotics without notifying her parents

NBME 19

Block 1/Question#1
53 yo woman w/GERD. Diet change, stress reduction do not ...
Omeprazole

Block 1/Question#4
66 yo man, 2 months of not being able to maintain an ...
Libido: decreased; Noctural erections: normal

Block 1/Question#7
48 yo woman, 2 weeks of fever and stool with mucus; recent ...
Entamoeba histolytica

Block 1/Question#13
What mechanism of action do tumor-suppressor genes have that ...
Inhibition of cell-cycle regulation

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

Block 1/Question#17
29 yo man with untreated HIV infection; what explains ...
CD8+ T lymphocyte–mediated killing

Block 1/Question#24
62 yo woman with sudden weakness of left leg; infarct in ...
Right anterior cerebral artery

Block 1/Question#26
Niemann-Pick disease is characterized by which of the following?
Decreased lysosomal hydrolase activity

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

Block 1/Question#31
32 yo man given primaquine for malaria prophylaxis; develops ...
Enzyme deficiency in the erythrocytes

Block 1/Question#34
12 yo girl unable to walk for 5 days but is unconcerned about ...
Conversion disorder

Block 1/Question#35
5 yo boy, R eye pain for 1 week; retinal exam shows a mass. ...
Retinal cells

Block 1/Question#36
36 yo woman presents to ED after believing she suffered a ...
Panic disorder

Block 1/Question#42
What advantage does randomized controlled study have over ...
Better control for confounding variables

Block 1/Question#44
Three tests are developed to identify rotavirus in children ...
Test 3 followed by test 1 if test 3 is positive

Block 1/Question#48
62 yo man, right-handed, suffers decreased speech fluency ...
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

Block 0/Question#0
A 27-year-old woman has an episode of pneumococcal pneumonia ...
Direct antiglobulin (Coombs) test

Block 0/Question#0
During an experiment, an isolated skeletal muscle is placed ...
pH

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
An 80-year-old woman is being evaluated for suspected ...
Additional testing to confirm the diagnosis of TA

Block 1/Question#6
A 55-year-old man with chronic bronchitis is brought to the ...
Naloxone

Block 1/Question#8
A 6-week-old girl is brought to the physician by her mother ...
Immature lower esophageal sphincter

Block 1/Question#14
A 21-year-old man comes to the emergency department because ...
Inferior rectal vein

Block 1/Question#20
A 24-year-old man with a history of intravenous drug use is ...
480

Block 1/Question#21
A 42-year-old farmer has a 7-mm red scaly plaque on the ...
Actinic keratosis

Block 1/Question#28
A 12-year-old boy is swimming in a mountain stream. He is ...
Central blood volume: increased; ADH (vasopressin): decreased; Atrial natriuretic peptide: increased

Block 1/Question#35
A 42-year-old woman comes to the physician because of a ...
Rosacea

Block 1/Question#38
A newborn has male genital ducts but female external ...
Scrotum

Block 1/Question#48
A 9-year-old girl is brought to the physician because of poor ...
Diverticulum of the roof of the embryonic oral cavity

Block 2/Question#4
A 28-year-old woman is brought to the physician because of a ...
Area labeled with letter 'C'

Block 2/Question#5
A 56-year-old man comes to the physician 4 hours after the ...
Right subthalamic

Block 2/Question#6
An 80-year-old woman comes to the emergency department ...
Hydrochlorothiazide

Block 2/Question#9
A randomized clinical trial is conducted to compare wound ...
Neither procedure is superior

Block 2/Question#11
A 13-year-old girl has a grade 2/6, holosystolic murmur that ...
Tricuspid

Block 2/Question#12
A 2-month-old boy is given a vaccine that has been ...
Haemophilus influenzae type b

Block 2/Question#13
A 28-year-old woman at 18 weeks' gestation has palpitations. ...
Free T4

Block 2/Question#19
A 21-year-old man is brought to the emergency department 45 ...
Streptococcus pneumoniae

Block 2/Question#20
A 38-year-old woman comes to the physician because of a ...
Proliferative endometrial tissue

Block 2/Question#22
A 60-year-old man comes to the physician because of a 1-month ...
Pleural effusion

Block 2/Question#24
A 65-year-old woman with ovarian cancer is treated with ...
DNA replication

Block 2/Question#27
In a clinical study, a polymorphic marker with three alleles, ...
2,3

Block 2/Question#33
A study is conducted to assess the effectiveness of ...
Placebo effect

Block 2/Question#34
A 40-year-old man is evaluated because his skin is extremely ...
Heme synthesis

Block 2/Question#35
A 40-year-old woman comes to the physician because of a ...
Sulfasalazine

Block 2/Question#39
A 40-year-old man with interstitial pulmonary fibrosis has a ...
Increased radial traction on airways

Block 2/Question#41
An investigator wishes to conduct a study of the development ...
Cohort

Block 2/Question#45
A 25-year-old woman comes to the physician because of a ...
21-Hydroxylase

Block 2/Question#46
A 38-year-old man is brought to the emergency department 30 ...
Metabolic acidosis

Block 3/Question#2
A 3-year-old boy and his 5-year-old brother bruise easily and ...
Factor VIII (antihemophilic factor)

Block 3/Question#9
A 40-year-old African American woman comes to the physician ...
1,25-Dihydroxycholecalciferol

Block 3/Question#11
A 30-year-old woman who is at 20 weeks' gestation comes to ...
Tracheoesophageal atresia

Block 3/Question#13
A 15-year-old girl is brought to the physician by her mother ...
First-degree burn

Block 3/Question#14
A 16-year-old boy is brought to the physician by his father ...
Luteinizing hormone

Block 3/Question#16
A 14-year-old boy is brought to the physician by his mother ...
Inhaled glue

Block 3/Question#19
A 65-year-old woman undergoes surgical repair of an aneurysm ...
Area labeled with letter 'A'

Block 3/Question#24
A 10-year-old girl is brought to the physician by her mother ...
Breast bud development

Block 3/Question#25
A physician is sad because he has to inform a patient of ...
Yes, it is.

Block 3/Question#26
A 34-year-old man is evaluated after becoming lightheaded ...
Sympathetic efferent activity: increased; parasympathetic efferent activity: decreased

Block 3/Question#27
A 44-year-old woman comes to the physician for a follow-up ...
Ubiquitin ligase

Block 3/Question#29
A 75-year-old man comes to the physician because of a 2-year ...
Increased hydrostatic pressure in Bowman space

Block 3/Question#31
A 20-year-old man is brought to the emergency department ...
Epinephrine

Block 3/Question#33
A female newborn delivered at 36 weeks' gestation is in ...
Incomplete formation of pleuroperitoneal membrane

Block 3/Question#36
An 18-year-old man with Crohn disease is admitted to the ...
T-lymphocyte function

Block 3/Question#37
A 4-year-old boy is brought to the physician by his parents ...
Congenital ureteral obstruction

Block 3/Question#38
Ten healthy human subjects are given a new oral drug and ...
Phase 1

Block 3/Question#41
A 27-year-old woman is admitted to the hospital because of a ...
Struvite

Block 3/Question#49
A previously healthy 48-year-old nulligravid woman comes to ...
Endometrial hyperplasia

Block 4/Question#1
An 83-year-old man is brought to the emergency department ...
Early septic shock

Block 4/Question#3
A 46-year-old man is treated with oral cyclosporine after a ...
Suppressing the early response of T lymphocytes to activation

Block 4/Question#4
A 54-year-old woman with hypertension and bilateral renal ...
Vasodilating prostaglandins at the afferent arteriole

Block 4/Question#10
A 32-year-old woman, gravida 2, para 1, at 7 weeks' gestation ...
Ectopic pregnancy

Block 4/Question#14
A 55-year-old man is admitted to the hospital for treatment ...
0.9% Saline

Block 4/Question#16
A 32-year-old man comes to the physician because of a 3-month ...
Tissue: Testicle; Effect: Estradiol production

Block 4/Question#20
A 45-year-old man comes to the physician because of yellow ...
Mallory hyaline

Block 4/Question#23
A previously healthy 72-year-old man is brought to the ...
Gastrointestinal blood loss

Block 4/Question#27
A 20-year-old man with suspected appendicitis has ...
T10

Block 4/Question#30
A 45-year-old man comes to the physician because of ...
Tumor necrosis factor

Block 4/Question#33
An otherwise asymptomatic 52-year-old woman comes to the ...
Failure of the ovaries to secrete 17β-estradiol

Block 4/Question#34
A 16-year-old girl comes to the physician because of a 2-year ...
Dopamine β-hydroxylase

Block 4/Question#36
A 41-year-old woman is evaluated because of increasingly ...
Fibromuscular dysplasia

Block 4/Question#40
A 48-year-old man comes to the physician because of ...
Increased intestinal iron absorption

Block 4/Question#47
A 10-year-old boy has had anemia since birth. His spleen is ...
Hereditary spherocytosis

NBME 16

Block 1/Question#1
A 27-year-old man who is being treated for Hodgkin lymphoma ...
Donor T lymphocytes reacting against host cells

Block 1/Question#2
An 18-month-old boy is brought to the emergency department ...
Long-chain acyl-CoA dehydrogenase

Block 1/Question#3
A 38-year-old woman comes to the physician because of a ...
Serum calcium concentration

Block 1/Question#5
A 24-year-old man comes to the physician because of nasal ...
α-Adrenergic agonist

Block 1/Question#7
A 2-year-old boy is brought to the physician because of ...
Amino acids: decreased; Glucose: decreased; Phosphate: decreased; HCO3: decreased

Block 1/Question#8
A 55-year-old man comes to the physician because of ...
Dextromethorphan

Block 1/Question#14
Lesch-Nyhan syndrome, an X-linked recessive disease, is seen ...
1/50,000

Block 1/Question#16
A 40-year-old woman is brought to the emergency department 1 ...
Decreased function of Na+–K+ ATPase

Block 1/Question#17
An investigator is studying the regulation of pulmonary ...
Intravenous infusion of 0.9% saline for 5 minutes

Block 1/Question#18
A screening program is instituted for detection of vaginal ...
10%

Block 1/Question#24
A 79-year-old woman is admitted to the hospital after ...
Go for a long walk outside daily

Block 1/Question#26
A 16-year-old boy is brought to the emergency department 30 ...
Area labeled by the letter 'E'

Block 1/Question#30
A 5-year-old boy is brought to the emergency department ...
Cerebral edema

Block 1/Question#37
A 54-year-old man has an aneurysm in the distal portion of ...
2.4

Block 1/Question#39
A 28-year-old woman comes to the physician because of a ...
Ureter

Block 1/Question#41
An 18-year-old man with acute lymphoblastic leukemia comes to ...
Amphotericin B

Block 1/Question#46
A 55-year-old woman comes to the physician because of a ...
Parathyroid hormone: decreased; 1,25-Dihydroxycholecalciferol: increased

Block 1/Question#47
A 24-year-old African American man comes to the physician ...
Pseudofolliculitis barbae

Block 1/Question#48
A 12-year-old boy is brought to the physician because of a ...
Abnormal myelin sheaths

Block 1/Question#49
During an experiment, the concentration of glycolytic ...
Glyceraldehyde-3-phosphate dehydrogenase

Block 2/Question#3
A 48-year-old woman comes to the physician because of a ...
Increased follicle-stimulating hormone

Block 2/Question#13
A 5-year-old boy is brought to the physician because of an ...
Lysosomes

Block 2/Question#18
An animal study is conducted to assess the effects of smoking ...
Mucus production and secretion: increased; Activity of airway cilia: decreased; Alveolar macrophage function: decreased

Block 2/Question#24
An 85-year-old woman is diagnosed with a fracture of the ...
Morphine is metabolized to active metabolites that accumulate

Block 2/Question#37
A 33-year-old man comes to the physician because of a 3-month ...
Glycogen phosphorylase

Block 2/Question#49
During an experimental study of oxygen consumption in the ...
Proximal tubule

Block 2/Question#50
A 35-year-old man comes to the physician because of a 3-year ...
Adenylyl cyclase

Block 3/Question#1
A 20-year-old man is brought to the physician because of a ...
Induction of cytochrome P450 enzymes that activate acetaminophen to a hepatotoxic metabolite

Block 3/Question#3
An 83-year-old man comes to the physician because of a 3-day ...
Bullous pemphigoid antigen

Block 3/Question#5
A 45-year-old man is admitted to the hospital because of ...
Iron

Block 3/Question#7
A 15-year-old girl is brought to the emergency department 12 ...
Increased absorption of calcium in the gastrointestinal tract

Block 3/Question#9
A 53-year-old homeless man with alcoholism is brought to the ...
Normal oral flora

Block 3/Question#12
An 18-year-old woman comes to the physician because of ...
Interstitial nephritis

Block 3/Question#17
A Gram stain is performed on a sputum specimen. Pink rods and ...
Outer membrane

Block 3/Question#20
An investigator is studying strains of Streptococcus ...
Natural transformation

Block 3/Question#24
An 8-year-old girl is brought to the physician for a ...
“Your daughter’s development is normal.”

Block 3/Question#25
A 27-year-old nulligravid woman comes to the physician ...
Clomiphene

Block 3/Question#26
A study is designed to evaluate the relationship between ...
Cross-sectional

Block 3/Question#30
A 54-year-old woman who works as a nurse comes to the ...
Interferon gamma

Block 3/Question#32
A 65-year-old woman comes to the physician because of a ...
Pulmonary small cell carcinoma metastatic to the brain

Block 3/Question#38
A 68-year-old man comes to the physician because of a 2-hour ...
Right ophthalmic

Block 3/Question#39
A 27-year-old woman comes to the physician because she is ...
Reassurance

Block 3/Question#40
A female newborn is delivered at term to a 35-year-old ...
Enlarged thyroid gland

Block 3/Question#41
A 70-year-old man comes to the physician because of ...
Schedule regular appointments to monitor the patient

Block 3/Question#45
A 25-year-old woman comes to the physician because of a ...
Fasting insulin: increased; Testosterone: increased; Luteinizing hormone: increased

Block 3/Question#50
A 10-year-old girl has fatigue and appears pale. Her father ...
Deficiency of erythrocyte spectrin

Block 4/Question#8
A 24-year-old woman comes to the physician for a follow-up ...
Tuberous sclerosis

Block 4/Question#11
A 78-year-old man comes to the physician because of fever, ...
Bacterial endocarditis

Block 4/Question#12
A 39-year-old woman with rheumatoid arthritis comes to the ...
Tumor necrosis factor-α

Block 4/Question#24
A 35-year-old man comes to the physician because of a 6-month ...
Gastrin

Block 4/Question#26
A 42-year-old woman undergoes biopsy of suspicious ...
High-grade, low-stage neoplasm

Block 4/Question#27
A previously healthy 18-year-old man is brought to the ...
Brief psychotic disorder

Block 4/Question#32
A 70-year-old woman is found to have persistent fever despite ...
Candida albicans

Block 4/Question#34
A 43-year-old woman comes to the physician because of ...
Degeneration of motoneurons of the lumbar cord

Block 4/Question#35
A 51-year-old woman comes to the physician because of a ...
Area labeled by the letter 'B'

Block 4/Question#39
A 32-year-old man begins to laugh while eating dinner with ...
While swallowing: closed; Immediately after laryngeal irritation: closed; while coughing: open

Block 4/Question#40
A new antiplatelet agent is developed for the prevention of ...
8%

Block 4/Question#45
A 42-year-old woman is brought to the emergency department 30 ...
Posterior communicating

Block 4/Question#48
A 32-year-old woman, gravida 4, para 0, aborta 3, delivers a ...
Unbalanced chromosome rearrangement

Block 4/Question#49
A 40-year-old woman comes to the emergency department because ...
Entamoeba histolytica

Block 4/Question#50
A 35-year-old woman participates in a study of a new ...
Day 12

Block 1/Question#15
A full-term female newborn develops respiratory distress ...
Congenital diaphragmatic hernia

Block 1/Question#24
A previously healthy 52-year-old man is brought to the ...
Binding of antibody to the acetylcholine receptor

Block 1/Question#25
A 54-year-old woman is admitted to the hospital with an acute ...
Grade 4/6, holosystolic murmur heard best over the lower left sternal border and the cardiac apex

Block 1/Question#26
A 40-year-old woman comes to the physician for an initial ...
Antagonizes VLDL-cholesterol secretion

Block 1/Question#31
A 55-year-old woman comes to the physician because of a ...
Parathyroid hormone: down; 1,25-Dihydroxycholecalciferol: up

Block 1/Question#34
A 39-year-old woman with type 1 diabetes mellitus comes to ...
Stimulation of hepatic glucose production

Block 1/Question#43
A 15-year-old boy is brought to the physician for an ...
Fibrillin

Block 1/Question#48
A newborn female is diagnosed with hypothyroidism 2 days ...
Thyroxine (T4)

NBME 15

Block 1/Question#6
A 7-year-old boy is brought to the physician because of a ...
Virion release

Block 1/Question#9
A healthy 3-year-old boy has a cleft lip and palate. He has ...
Multifactorial

Block 1/Question#10
Which of the following best explains why deoxygenated blood ...
Deoxyhemoglobin is a better buffer of hydrogen ions than oxyhemoglobin

Block 1/Question#11
A 9-year-old boy has mild mental retardation and a 4-year ...
Tuberous sclerosis

Block 1/Question#15
A 48-year-old woman comes to the emergency department because ...
Increased cardiac parasympathetic activity

Block 1/Question#19
A 65-year-old man with a history of ischemic heart disease ...
33%

Block 1/Question#24
A 3-year-old girl is brought to the physician because of a ...
Interferon-gamma receptor

Block 1/Question#32
A 4-day-old male newborn who was born at home is brought to ...
First

Block 1/Question#33
A 75-year-old woman is brought to the physician because of a ...
Releases NF-κB after undergoing phosphorylation

Block 1/Question#35
One-half hour after an uncomplicated vaginal delivery, a ...
Oxytocin

Block 1/Question#37
A 36-year-old man who is heterozygous for an LDL-receptor ...
LDL receptor

Block 1/Question#38
A 23-year-old woman comes to the physician because of a 3-day ...
Oculomotor nerve

Block 1/Question#39
An investigator is designing a study to compare a new ...
Stratification

Block 1/Question#44
A 59-year-old man comes to the physician because of a 10-day ...
Imatinib

Block 1/Question#46
A 6-year-old boy with severe mental retardation and ...
0.2 to 0.5

Block 1/Question#48
A 22-year-old man is brought to the emergency department 30 ...
Deep fibular (peroneal)

Block 1/Question#49
A 23-year-old woman comes to the physician because of a ...
Glucokinase

Block 1/Question#50
A healthy 25-year-old man participates in a study of muscle ...
epp Amplitude: 1; mepp Amplitude: 1; Response to Ach: 1

Block 2/Question#3
A 2-year-old girl is brought to the emergency department 20 ...
Atropine

Block 2/Question#4
A 32-year-old man comes to the physician for his annual ...
Schizoid personality disorder

Block 2/Question#6
A 56-year-old woman comes to the physician because of a ...
Helicobacter pylori

Block 2/Question#9
A 67-year-old man is brought to the physician because of a ...
Aneurysm of the posterior communicating artery

Block 2/Question#11
A previously healthy 48-year-old man is brought to the ...
Degenerating epithelial cells and dirty brown granular casts

Block 2/Question#14
A 25-year-old woman with a history of rheumatic fever and ...
Streptococcus mitis

Block 2/Question#15
A 64-year-old man comes to the physician because of a 2-month ...
Increased fibrosis in the interstitium

Block 2/Question#20
A 30-year-old man is brought to the physician by his wife ...
Porphobilinogen deaminase

Block 2/Question#21
A 43-year-old woman comes to the physician because of a ...
Complex partial

Block 2/Question#22
A 22-year-old woman is found to be HIV positive after sexual ...
Protein processing

Block 2/Question#23
A previous healthy 26-year-old woman comes to the physician ...
Area labeled by letter 'E'

Block 2/Question#26
A 47-year-old man is admitted to the hospital for treatment ...
Increased pulmonary capillary pressure

Block 2/Question#28
A 35-year-old woman, gravida 1, para 1, comes to the ...
Nicotinic acetylcholine receptor

Block 2/Question#29
A 2-month-old male infant is brought to the emergency ...
Glycine receptor

Block 2/Question#31
A 24-year-old woman with Marfan syndrome comes to the ...
Hypervolemia

Block 2/Question#32
A 25-year-old primigravid woman at 25 weeks' gestation comes ...
Prematurity

Block 2/Question#36
A 72-year-old woman is admitted to the hospital because of an ...
Left coronary, circumflex, posterior interventricular (posterior descending)

Block 2/Question#39
A 43-year-old man with a 10-year history of alcoholism comes ...
Decreased glutathione

Block 2/Question#40
A 4-year-old boy is brought to the physician by his father ...
Cytoskeleton

Block 2/Question#41
A 45-year-old man comes to the physician for an initial ...
Mitral regurgitation

Block 2/Question#43
A 37-year-old woman is brought to the emergency department ...
Cardiogenic

Block 2/Question#45
A 3-year-old girl is brought to the physician because of a ...
Abnormal targeting of these enzymes to lysosomes

Block 2/Question#47
A 75-year-old man with chronic obstructive pulmonary disease ...
C5a

Block 2/Question#49
A study was begun in the 1950s to determine the causes of ...
Cohort study

Block 3/Question#3
A 56-year-old woman is brought to the emergency department by ...
Lipopolysaccharide

Block 3/Question#6
A 50-year-old man comes to the physician for a routine health ...
Medullary

Block 3/Question#7
A 1-year-old boy is brought to the physician by his parents ...
RNA splice error

Block 3/Question#9
A newborn undergoes surgical repair of esophageal atresia. ...
Endoderm

Block 3/Question#10
A 5-year-old boy is stung on his foot by a bee. Within 30 ...
Gap formation between endothelial cells

Block 3/Question#15
A 65-year-old man with hypertension volunteers to participate ...
Acid-base: Metabolic alkalosis; Volume contraction: yes

Block 3/Question#18
A 27-year-old man comes to the physician because of a 3-hour ...
Prolonged fecal excretion of the organism

Block 3/Question#24
A 28-year-old African American man comes to the physician ...
Ethnicity

Block 3/Question#30
A 13-year-old boy is scheduled to receive chemotherapy for a ...
T-lymphocyte thymocytes localized to the thymic cortex

Block 3/Question#32
A 2-month-old girl is brought to the physician for a ...
Congenital neutropenia

Block 3/Question#39
A 42-year-old woman with multiple sclerosis is brought to the ...
Medial longitudinal fasciculus

Block 3/Question#43
An 18-year-old man is brought to the physician by his father ...
Inquiry about a history of anabolic steroid use

Block 3/Question#45
A 30-year-old woman has had Hodgkin disease that was ...
Therapy for Hodgkin disease causes mutations in hematopoietic stem cells, and one mutant cell progresses to leukemia

Block 3/Question#47
A 2-month-old boy is brought to the physician because of ...
Peroxisomes

Block 3/Question#48
A paper says, "We chose the sample size to have an 80% power ...
5%, Type I error

Block 4/Question#3
A 51-year-old man with a 5-year history of Wegener ...
Hematuria

Block 4/Question#5
A male newborn is delivered at term with a right-sided aortic ...
Third and fourth branchial pouches

Block 4/Question#7
A 17-year-old boy with chronic renal insufficiency undergoes ...
Hydronephrosis

Block 4/Question#8
A newborn delivered at 28 weeks' gestation is in severe ...
Lung elastic recoil

Block 4/Question#9
A 40-year-old woman with breast cancer is brought to the ...
Occipital lobe

Block 4/Question#11
A 45-year-old man comes to the physician for a follow-up ...
Venous return: decreased; Carotid sinus baroreceptor activity: decreased; Cerebral blood flow: decreased

Block 4/Question#17
A previously healthy 18-year-old woman comes to the physician ...
β-Lactamase production

Block 4/Question#20
A 52-year-old man is brought to the physician 3 days after ...
No constriction because the retinal ganglion cells in the left eye have been destroyed

Block 4/Question#25
A couple has two children with osteogenesis imperfecta type ...
Germline mosaicism

Block 4/Question#26
A 65-year-old woman comes to the physician for a follow-up ...
Osteoblast activity: decreased; Osteoclast activity: increased; RANKL: increased

Block 4/Question#29
A 45-year-old woman (III,7) comes to the physician for a ...
Incomplete penetrance

Block 4/Question#30
A 25-year-old woman comes to the physician because of ...
Nuclear/retinoid X binding to DNA

Block 4/Question#32
A 70-year-old woman is found dead in her bed in a skilled ...
Hypertrophy

Block 4/Question#33
During a series of normal skeletal muscle twitches, the ATP ...
ATP is quickly regenerated from creatine phosphate

Block 4/Question#38
A 25-year-old woman comes to the physician because of general ...
Thrombocytopenia

Block 4/Question#40
An 18-month-old boy with severe combined immunodeficiency ...
Irradiated packed red blood cells

Block 4/Question#42
A 4-year-old boy with a karyotype of 47,XY+21 develops ...
Excess lymphoblasts

Block 4/Question#44
A 72-year-old woman comes to the physician because of diffuse ...
Osteomalacia

Block 4/Question#47
A 31-year-old woman is treated for Plasmodium vivax malaria ...
Primaquine kills hypnozoites

Block 4/Question#48
A study is conducted to evaluate the effectiveness of cough ...
Lack of blinding between groups

NBME 13

Block 1/Question#1
A 77-year-old woman dies in the hospital after a long ...
Interleukin-1 (IL-1)

Block 1/Question#13
An 18-month-old boy is brought to the physician because of ...
Iduronate sulfatase

Block 1/Question#19
A 22-year-old woman comes to the physician 3 months after she ...
Anterior to the sternocleidomastoid muscle

Block 1/Question#20
A 3-year-old girl is found to have a grade 4/6, loud, harsh, ...
Ventricular septal defect

Block 1/Question#25
A 32-year-old woman comes to the physician because of a ...
Myasthenia gravis

Block 1/Question#26
A 4-year-old boy is brought to the emergency department ...
Reaction step labeled by the letter 'E'

Block 1/Question#27
A 12-year-old African American girl is brought to the ...
Polymerization of hemoglobin with hypoxic conditions due to amino acid substitution in the β chain

Block 1/Question#29
A 43-year-old woman with metastatic colon cancer has ...
The agent being a humanized antibody

Block 1/Question#30
A 43-year-old man comes to the physician for a routine health ...
Low-calorie

Block 1/Question#41
A 20-year-old man has cramping periumbilical pain. After ...
Interleukin-1 (IL-1)

Block 1/Question#43
An 18-year-old man has had temperatures to 38.3°C (101°F), a ...
T lymphocytes

Block 1/Question#48
A male newborn at 34 weeks' gestation is delivered vaginally. ...
Endothelium

Block 2/Question#1
A 15-year-old boy is brought to the physician by his mother ...
Type I (immediate) hypersensitivity

Block 2/Question#6
A female newborn is delivered at 34 weeks' gestation in an ...
Nitric oxide

Block 2/Question#8
A 5-month-old boy is brought to the physician because of a ...
Thyroglossal duct

Block 2/Question#9
In order to determine risk factors for death from coronary ...
Observational cohort study

Block 2/Question#21
A 36-year-old man who is seropositive for HIV has had a ...
Pneumocystis jiroveci (formerly P. carinii)

Block 2/Question#30
A 47-year-old woman comes to the physician because she wants ...
Activation of nuclear gene transcription

Block 2/Question#38
A 5-year-old boy is brought to the physician by his mother ...
Ischium

Block 2/Question#41
A 23-year-old woman comes to the physician because of a ...
Dextromethorphan

Block 2/Question#45
A 54-year-old man has a squamous cell carcinoma of the right ...
Loss of heterozygosity

Block 3/Question#5
A previously healthy 42-year-old Asian woman is brought to ...
Induction of cytochrome P450

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

Block 3/Question#7
A 32-year-old woman comes to the physician because she has ...
Clomiphene

Block 3/Question#11
A 31-year-old woman is brought to the emergency department by ...
Desensitization of nicotinic receptors

Block 3/Question#14
A previously healthy 40-year-old man is brought to the ...
Increased protein degradation

Block 3/Question#15
A 33-year-old woman who is right-handed is brought to the ...
Voltage-gated Na+ channels

Block 3/Question#19
A study is conducted to evaluate the onset and course of ...
Population-based

Block 3/Question#21
An autopsy is done on a 46-year-old woman who died of ...
Paraganglioma

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

Block 3/Question#31
A 23-year-old woman with type 1 diabetes mellitus is brought ...
Inability to produce hydroxy-halide radicals

Block 3/Question#35
A 25-year-old woman undergoes a radical mastectomy with ...
Compression sleeve

Block 3/Question#39
A young adult couple has been unable to conceive for the past ...
Seminal vesicles

Block 3/Question#45
A 25-year-old man with cystic fibrosis comes to the physician ...
Biofilm formation in the lower respiratory tract

Block 4/Question#2
An 18-year-old woman with mild mental retardation is brought ...
Apo B

Block 4/Question#7
A mouse melanoma, B-16, is highly metastatic. A clone of the ...
Homing

Block 4/Question#13
A 22-year-old woman comes to the physician for a follow-up ...
Antiphospholipid antibody syndrome

Block 4/Question#20
A previously healthy 32-year-old man is brought to the ...
Alcohol dehydrogenase

Block 4/Question#21
A 40-year-old woman is brought to the emergency department 30 ...
Vascular malformation

Block 4/Question#34
A 33-year-old woman comes to the physician because of a 16-kg ...
Cortical hyperplasia

Block 4/Question#35
A 55-year-old man with hepatic encephalopathy is brought to ...
Lactulose

Block 4/Question#36
A previously healthy 25-year-old man is admitted to the ...
Alveolar hyaline membrane

Block 4/Question#42
A 64-year-old woman comes to the physician because of a ...
Esophageal peristalsis: decreased; Lower esophageal sphincter tone: decreased

Block 4/Question#46
A 62-year-old man is brought to the emergency department ...
Pulmonary edema