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