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